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The latest news on Obamacare from Business Insider

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    donald trump lisa murkowski

    Congressional sources say President Donald Trump has told Republican senators that the House healthcare bill is "mean" and that the Senate version should be "more generous."

    The remarks were a surprising critique of a Republican-written House measure whose passage Trump fought for and embraced. They also seem to undercut efforts by Senate conservatives to impose restrictions in their chamber’s legislation, such as curbing the Medicaid health care program for the poor and limiting the services insurers must cover.

    Trump memorably held a Rose Garden ceremony with House GOP members after the American Health Care Act passed the chamber last month. There, he called the House legislation a "great plan" and said it was "very, very, incredibly well-crafted."

    The sources say the president did not say what aspects of the bill he was characterizing.

    Trump’s comments were described by people who received accounts of a White House lunch Trump had Tuesday with 15 GOP senators. They spoke on condition of anonymity to reveal a closed-door conversation.

    The Congressional Budget Office analysis of the American Health Care Act found that 23 million more people would be without insurance in 2026 under the bill than the current baseline. Additionally, it found that healthcare costs for poorer, older Americans would skyrocket.

    The comments also reflect some of the public comments made by Trump prior to the luncheon.

    "The House has passed a bill and the Senate is working very, very hard — and specifically the folks in this room. I appreciate what you're doing — to pass a phenomenal bill for the people of our country," Trump said with media in the room. "Generous, kind, and with heart. That might mean adding additional money into it."

    AshLee Strong, a spokeswoman for House Speaker Paul Ryan, said "congressional Republicans, with President Trump’s support, are working to repeal and replace this terrible Obamacare law that is harming Americans."

    Senate GOP leaders are currently writing their healthcare bill, though Democrats and even some fellow Republicans have not seen any of the legislative text.

    There are a few issues that still divide the Republican conference, including funding the Affordable Care Act's Medicaid expansion.

    Senate Majority Leader Mitch McConnell reportedly wants to have a vote on the bill before the week-long July 4 recess.

    SEE ALSO: Top GOP senator: The secretive process of writing the healthcare bill is 'like having a baby'

    Join the conversation about this story »

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    john cornyn mitch mcconnell

    Senate Majority Whip John Cornyn had a colorful way to describe the secretive process of crafting a healthcare bill during an interview on Monday.

    "It's like having a baby. It's not here yet, but it's coming,"Cornyn told Politico.

    That due date comes soon. The GOP is closing in on a deal for a bill to repeal and replace the Affordable Care Act, the law colloquially known as Obamacare, outside of the public eye.

    But before the bill debuts, a few key points of disagreements among Republicans need to be ironed out.

    A hushed process and soft timelines

    In an attempt to avoid the heavy backlash and ensure disagreements in the conference don't spill out into plain — as was the case in the House GOP's fight over the American Health Care Act — the Republican Senate majority is crafting the bill largely behind closed doors.

    Senate Majority Leader Mitch McConnell and other leaders have reportedly been crafting the bill with a small group of GOP senators. But many members, even Republicans, have no idea what the text of the bill contains.

    According to Bloomberg's Sahil Kapur and Laura Litvan, Republican Sens. Ron Johnson, Bob Corker, Bill Cassidy, Lindsey Graham and Jeff Flake all said they had not seen the healthcare bill.

    "I think we have to really take a look at this, and I think the American people need to take a look at it," Johnson told Bloomberg.

    This secretive process has infuriated Democrats, who are accusing Republicans of hiding behind closed doors because the House version of healthcare legislation became so unpopular with the American public.

    "The Republican majority is afraid of the American people learning what is in their healthcare bill," Senate Minority Leader Chuck Schumer said on the Senate floor Tuesday. "They don’t want the American people to know how much they cut and destroy Medicaid, or how fat of a tax break they give to the wealthiest few, because they know the backlash will be severe. In short, by their actions it seems our Republican colleagues are ashamed by this bill."

    According to Politico, it is unlikely that the bill will be public for long before it is brought to the floor for a vote.

    Leadership desires to get a vote on the bill before a week-long July 4 recess, meaning there would be little time between the bill's release and a vote.

    Key issues

    Reports have suggested a few major problems preventing Republicans from coming together behind one bill and advancing it to the floor for a vote.

    While the bill is likely to look similar to the House AHCA on many major aspects, several key issues will decide whether Senate Republican leaders can get the bill passed.

    Among those problems include how long to continue funding for Obamacare's Medicaid expansion. The program allowed states to increase the threshold for Medicaid enrollees to 138% of the federal poverty limit. Many states controlled by Republicans took the extra funding from the federal government, so the House bill's repeal of the funding in 2020 has gotten pushback from senators in those states.

    Conservatives like Sens. Ted Cruz and Rand Paul have also come out against a slower phase-out of this funding, making a compromise more difficult.

    Other problems include funding for tax credits to allow people to gain access to insurance coverage and maintaining Obamacare's essential health benefits, which mandate a minimum of health procedures that insurance plans must cover.

    With only a 52-seat majority, Republicans have little wiggle room to have members turn against the bill.

    SEE ALSO: Obamacare just got some much-needed good news

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    Ohio Governor and former presidential candidate John Kasich speaks to reporters after an event honoring the Cleveland Cavaliers, the 2016 NBA championship team, at the White House in Washington in this file photo dated November 10, 2016. REUTERS/Kevin Lamarque

    The road to repealing and replacing the Affordable Care Act, the law better known as Obamacare, has been rocky for Republicans. And Ohio Gov. John Kasich's approach going forward could signal which path the party takes.

    While the House of Representatives passed the American Health Care Act, their plan to overhaul the healthcare system, in early May, the legislation was unpopular with the public. And Senate Republicans have since indicated that they are writing their own version of the bill.

    The House bill, which was altered from an initial version to gain the support of the hardline conservative House Freedom Caucus, has no chance of passing the far more moderate Senate, where Republicans operate with a slim 52-to-48 majority.

    One of the most contentious aspects of the AHCA is its proposed rollback of Medicaid, the government-run health program that provides insurance primarily to pregnant women, single mothers, people with disabilities, and seniors with low incomes.

    The AHCA would end the government's commitment to funding the expansion to Medicaid established by Obamacare, which extended eligibility for the program to include any adult living under 138% of the federal poverty level.

    Thirty-two states and the District of Columbia have chosen to participate, leading to more than 11 million new people nationwide gaining coverage, a number that continues to grow. 

    The Medicaid expansion has been extremely popular, both with the public and elected officials on both sides of the aisle. While 16 Republican governors have come out in favor of the expansion, Ohio Gov. John Kasich has been the most outspoken. It has made him something of a kingmaker when it comes to healthcare reform in Washington.

    Senate Majority Leader Mitch McConnell can only afford to lose two votes in order to pass a Senate bill. Four Republican senators  — Sens. Rob Portman, Shelley Moore Capito, Cory Gardner, and Lisa Murkowski — all came out against the AHCA in March due to its handling of the Medicaid expansion. 

    Kasich's stance on the bill could signal or even dictate where Portman, a senator from Ohio, or the other senators in the group stand.

    bi graphicsmedicaid expansion

    Nowhere was the importance of Kasich's opinion more apparent than when the New York Times reported Tuesday that Kasich had said he would accept a "gradual phaseout" of the Medicaid expansion, provided that such a phaseout provided more funds than the AHCA and more flexibility in how to administer the program. 

    "I don’t have a problem with phasing down the enhanced federal payments," Kasich told the Times. "But it can’t be done overnight, and it has to be done with the resources and the flexibility that are needed so people don’t get left behind. You just can’t be cutting off coverage for people."

    Kasich said that a seven-year phaseout of the Medicaid expansion — which Senate Republicans, including Portman, are reportedly discussing in closed-door meetings — would be acceptable if states were given more autonomy over the program. The AHCA, the House's bill, would end funding the expansion in 2020, among other sweeping changes.

    Kasich's statements would seem to suggest that Senate Republicans could be close to a workable compromise on Medicaid, and therefore a healthcare bill as a whole.

    But several hours after the Times' story published, Kasich published a cryptic statement:

    John Weaver, a Kasich strategist, then said on Twitter that Kasich does not support any "CURRENT plan" in either the Senate or the House, which he said included the seven-year phaseout. 

    Kasich and Weaver's quick response to the Times story suggests the Ohio governor is well aware how much his "rubber stamp" could mean to Senate Republicans stuck in a difficult and increasingly unpopular bid to pass healthcare reform. 

    The Senate GOP must forge a compromise bill that will not only make it out of the upper chamber, but gain enough support among the more conservative elements of the House to pass there. Additionally, procedural rules in the Senate prevent major overhauls to Obamacare, as GOP Sens. Chuck Grassley and Joni Ernst acknowledged in May.

    Join the conversation about this story »

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    Mario Schlosser

    Oscar Health, the $2.7 billion health-insurance startup, is going to start offering health insurance plans alongside the Cleveland Clinic in Ohio for the first time. 

    Oscar was co-founded by Josh Kushner, whose brother Jared is one of President Donald Trump's senior advisers. The health insurer originally focused on offering insurance through the Obamacare exchanges. The new plans with the Cleveland Clinic, a 96-year-old academic medical center, will also be offered on the exchanges. 

    This is the first time the Cleveland Clinic will be offering a health insurance plan under its name. 

    Here's what it'll look like: If you live in northeast Ohio and want to buy one of the Oscar-Cleveland Clinic plans, you sign up through Oscar's website as you might if you were in one of the other areas where Oscar operates (today, that's New York, California, and Texas). You'll use Oscar's apps and concierge services, but your clinical team will be healthcare professionals from the Cleveland Clinic at its hospitals and medical centers. 

    "This relationship goes beyond the traditional approach of getting sick and seeing the doctor," Cleveland Clinic chief of staff Brian Donley said in a news release. "Instead, it's about getting people the right care, at the right place, at the right time. It's about avoiding an unnecessary trip to the doctor or a stay in the hospital, whenever possible, through better patient education, better access to care, better care coordination, better behaviors and, ultimately, better health."

    The move comes at a time when there's a lot of uncertainty about the future of healthcare in the US. In May, the House passed the GOP's Obamacare replacement bill, and Senate Republicans are quietly crafting their own bill. If either one becomes law, it could drastically upend the individual exchanges that are Oscar's bread and butter. 

    Oscar's chief technology officer Alan Warren told Business Insider that the company has seen things stabilize. And, if a new law replaces the Affordable Care Act, Warren said it won't change anything about the co-branded Cleveland Clinic health plans. 

    For now, the plans are just for individuals, but Warren said the hope is to expand into the small group market as well.

    SEE ALSO: A new kind of doctor's office charges a monthly fee and doesn't take insurance — and it could be the future of medicine

    DON'T MISS: Health insurance startup Oscar has a new way to get all your medical details in one place for your doctor

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    Donald Trump Paul Ryan AHCA rose garden white house

    On Tuesday, reports surfaced that President Donald Trump called the House GOP's healthcare bill "mean" during a lunch with Republican senators who are crafting their own version of the bill.

    Axios' Jonathan Swan reported that House GOP lawmakers who voted for the American Health Care Act are not happy with the president's assessment. 

    A Republican House member told Swan that Trump's reversal on a bill he helped sell was shocking, saying, "for him to turn around and do this, it's stunning. I can't believe it."

    Other reports said Trump called the bill a "son of a b----" and told senators at the luncheon their version of the AHCA needed to be more "generous."

    The criticisms appeared to stem from the fact that nonpartisan analysis projected healthcare costs for elderly and lower-income Americans would increase dramatically under the AHCA. The Congressional Budget Office also estimated that 23 million more Americans would be without insurance in 2026 compared to the current baseline.

    Trump's comments come just a few weeks after Trump celebrated the AHCA's passage with House Republicans during a White House Rose Garden ceremony after personally lobbying many members to support the bill.

    According to Swan, a Democrat on the House Ways and Means Committee trolled Republicans over the comment during a bill mark-up on Thursday.

    "See, we told you your health care bill was mean," the member said. "Now the president agrees with us."

    SEE ALSO: The Senate GOP healthcare bill is coming together — even though almost no one knows what's in it

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    mitch mcconnell

    Senate Republican leaders are keeping their healthcare bill quiet — very, very quiet.

    Despite reports Senate Majority Leader Mitch McConnell is attempting to bring the bill for a vote before the week-long July 4 recess, there remains no public text of any proposed legislation, and therefore no Congressional Budget Office score. There have also been no public hearings on changes made to the House version of the bill.

    While a core group of GOP senators is working on the bill, it appears that not all Senate Republicans even know what could be in it.

    McConnell is likely able to keep the bill under wraps until days before a final vote. By all indications that is the path the Republicans will take to try to ensure its passage.

    The secretive process has drawn the ire of Democratic lawmakers and activists, who have argued that Republicans attacked Democrats for "backroom deals" on the Affordable Care Act, the law known as Obamacare, despite that bill getting dozens of hearings and hundreds of amendments from both sides. 

    Even some Republicans aren't happy.

    The logic behind it all

    Public backlash during the House deliberation on its healthcare legislation, the American Health Care Act, was intense. Lawmakers received a deluge of calls from constituents against the bill. Think tanks and health policy experts — both conservative and liberal — picked the bill apart. Analyses showed the bill would result in higher prices for older and sicker Americans, coverage losses, and a slew of other negative side effects.

    The furor increased after the CBO score estimated that 23 million more people would go without insurance under the American Health Care Act by 2026 than under the current system.

    Republican leaders in the Senate have sought to avoid similar public fury, while writing its own version of the bill. McConnell can only lose three votes to pass the legislation, so any wavering on the bill by GOP members could doom it.

    The House vote was incredibly close, and 20 Republicans ended up voting against the bill.

    'I don't know. We just don't know.'

    The secretive Republican process has frustrated not only Democratic lawmakers — Senate Minority Leader Chuck Schumer said Republicans must be "ashamed" of the bill to keep it secret — but also many GOP lawmakers.

    The New York Times' Thomas Kaplan and Robert Pear spoke to a number of Republican senators who seemed less than pleased with the process so far.

    "The process is better if you do it in public, and that people get buy-in along the way and understand what’s going on," Sen. Bob Corker of Tennessee told the Times."Obviously, that’s not the route that is being taken."

    "Seems like around here, the last step is getting information, which doesn’t seem to be necessarily the most effective process," said Sen. Ron Johnson of Wisconsin. He also told reporters it's "not a good process" unless he gets time to read the bill.

    Sen. Rand Paul, a Republican who long advocated for a full repeal of Obamacare, expressed misgivings with the process and so far hasn't liked what he's heard from leadership.

    "I think it's being written, uh, by someone somewhere but I'm not aware of who or where,"Paul told NBC News."If you get a copy of it, will you send me a copy?"

    Sen. Bill Cassidy, a doctor from Louisiana who has proposed his own healthcare legislation, also expressed his desire for a more open process.

    "Would I have preferred a more open process? The answer is yes." Cassidy said.

    Finally, Sen. Lisa Murkowski of Alaska, a possible swing vote on the bill, told Vox that she is unable to give clear answers to constituents about what's in the bill. Murkowski's state depends heavily on the ACA's expansion of Medicaid, which the House bill would eliminate. Murkowski said it's unclear if that cut would remain in the Senate bill.

    "Is it the framework of the House-passed bill and then we're filling in our own details? I don't know," Murkowski told Vox's Dylan Scott."We just don't know. My constituents expect me to know, and if we had utilized the process that goes through a committee, I would be able to answer not only your questions but my constituents' questions."

    SEE ALSO: House Republicans 'can't believe' Trump called their healthcare bill 'mean'

    Join the conversation about this story »

    NOW WATCH: 'Where is Sean?': Things got awkward when April Ryan asked Sarah Sanders why Spicer didn’t attend the WH briefing

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    queen elizabeth nurses

    Since Republicans took over Congress, Obamacare has become more popular. Surveys from the Kaiser Family Foundation show the number of Americans supporting it went from 38% a year ago to 49% today.

    But Obamacare, itself a compromise, has real problems, and its limitations — and the growing backlash to Republican efforts to repeal it — have given an opening to an idea that until now has had little traction in the US.

    The idea is single-payer healthcare, and if the US adopted it, it'd be a radical change. At its core, the idea is that the government, in some form, would pay for all or most healthcare expenses.

    In business circles, states, and even the top levels of some insurers bringing some form of a single-payer healthcare system is beginning to gain traction.

    California's legislature is considering a bill that would institute a single-payer system, and Nevada's legislature just passed a bill to expand publicly funded Medicaid to all residents.

    Business leaders including famed investor Warren Buffett and Charlie Munger said that single-payer healthcare is the solution to the increasingly high levels of healthcare expenditures in the US. Even Aetna CEO Mark Bertolini, the top executive at one of the five major publicly traded US insurers, said at a staff meeting in May that a modified form of single-payer is a "conversation" the US should begin to start.

    On Capitol Hill, while the American Health Care Act would take the US further away from single-payer, Sen. Bernie Sanders has again introduced his Medicare-for-all bill that would create a single-payer system.

    During his campaign, Sanders showed that the appetite among the American left is growing for the policy. So what exactly is single-payer?

    While it may seem simple enough, there are actually a number of different forms a government-funded healthcare system could take.

    We've broken down the single-payer healthcare systems in Canada, the UK, and Taiwan, along with one non-single-payer but intriguing option in Germany, to see where the US system could go next. While these breakdowns aren't comprehensive, they highlight the types of single-payer systems that the world uses.

    The basics

    There are a few ways that single-payer can work, but at its core it is the government paying for healthcare services through revenue generated via taxation.

    Put another way, people who live in a country pay into a pot of money through their taxes. The government then takes this pot of money and pays drugmakers, healthcare facilities, and doctors.

    One of the hallmarks of a single-payer system is the ability for the government to have more control over prices.

    For instance, in many single-payer systems, the government can negotiate prices for prescriptions drugs since it controls the purse for much of the spending. This makes sense because in the case of the UK, nearly 80% of the healthcare spending comes from the government. So if a drug is not bought by the government, it almost totally closes off the market to a pharmaceutical company. This gives the government a lot of bargaining power.

    Payments to healthcare providers, prescription drugs, and other aspects of the system are all subject to price negotiation with the government in single-payer systems.

    Across different countries, however, it can take different forms.

    Canada: government single-payer, but private healthcare providers

    Canada's single-payer system is mostly run by provincial and territorial governments, but is funded heavily by the federal government. The federal government also sets baselines of standards for care at the provincial level.

    Each province sets its own ambulance fees, reimbursement rates for doctors, and other system fees. Most of the costs are covered by the government or supplemental private insurance, but out-of-pocket spending accounted for 14% of all healthcare spending in 2014 (a bit higher than the 11% in the US).

    The federal government does set some national cost standards, however, including for pharmaceuticals. The Patented Medicine Prices Review Board is federally run and helps to negotiate and set the prices for drugs under patent. While the Pan-Canadian Pharmaceutical Alliance handles some drugs not on patent, provincial governments handle the bulk of the negotiations over the prices.

    Many Canadians opt to get additional private insurance because it covers things that aren't publicly reimbursed like dental and eye care and has some nicer benefits like private rooms in hospitals and rehab care. So while public insurance is a base layer, the optional private insurance goes a step beyond.

    While two-thirds of Canadians have private insurance, the bulk (94%) of the costs are paid by employers, unions, and groups. Private insurance costs made up roughly 12% of total healthcare spending in 2014, compared to 33% of healthcare spending in the US. (The rest is Medicare and Medicaid.)

    In terms of facilities, most primary-care doctors are private individuals or groups who receive reimbursement from the government. Hospitals are a mix of public and private, with a bulk being nonprofit, with some provinces having a heavier weighting toward private facilities.

    Key spending facts:

    Healthcare spending per capita (2014): $4,728

    Out-of-pocket spending per capita (2014): $644

    Percent of GDP spent on healthcare (2015): 10.1% (11th-highest among OECD)

    Percent of healthcare costs from the government: 69.8%

    The UK: nationalized hospitals, private insurers

    The UK technically has four different national healthcare systems, one for each country that makes up the union, but the general construct is known as the National Health System.

    Within the NHS, there is a system of smaller community health boards that help ensure that national standards for care, cost, and efficiency are maintained.

    For patients, the NHS is generally "free at the point of use," meaning that when you go to a hospital or doctor's office there are no bills or co-pays.

    The UK pays for all this using both a specific national insurance tax on people making more than £157 per week and general tax funds to provide 98.8% of the funding for the NHS. The other 1.2% is paid for by out-of-pocket costs for things like prescriptions and dental care. The cost of co-payments for the out of pocket procedures are set by the NHS.

    About 66% of primary-care doctors are private contractors. The doctors, called general practitioners (GPs), receive payment at a rate set between their lobbying group the British Medical Association and the NHS. In contrast to the US, many doctors assign a patient a specific time to arrive at the doctor, rather than providing options the patient can choose from.

    A large majority of patients get their services from NHS-funded hospitals, but there are private-care facilities that can offer more specialized care or shorter wait times.According to the government, in 2012-2013, 8.77 million people received surgery at a NHS hospital compared to 1.61 million in private facilities.

    There is some private insurance that can be added on top of the basic NHS policy, but in 2015 only 10.5% of those in the UK elected to add on the coverage. Most of these policies do not cover the basics from the NHS, but provide additional coverage for specialized care or going to a private healthcare provider.

    Key spending facts:

    Healthcare spending per capita (2014): $4,094

    Out-of-pocket spending per capita (2014): $586

    Percent of GDP spent on healthcare (2015): 9.8% (13th-highest among OECD)

    Percent of healthcare costs from the government: 79.5%

    See the rest of the story at Business Insider

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    Donald Trump Paul Ryan

    House Republicans aren't too pleased that President Donald Trump privately spoke ill of their healthcare bill.

    After the president reportedly called the legislation "mean" and a "son of a b----" during a meeting with GOP Senators last week, some House Republican lawmakers were perturbed. This was, after all, a bill for which Trump personally lobbied, and he celebrated its passage with a Rose Garden ceremony.

    Now, however, some Republicans fear the comment may actually come back to haunt them.

    Democrats have begun to use the line in fundraising emails and will soon roll out ads featuring the comment to try and capitalize on backlash on the deeply unpopular American Health Care Act.

    According to The Washington Post, the Democratic Senatorial Campaign Committee is planning to use the "mean" comment in ads against several House GOP lawmakers who could run for Senate next year in Pennsylvania.

    Similarly, several Democratic and liberal groups have used the language in fundraising emails since the reports surfaced.

    According to Politico's Josh Dawsey and Seung Min Kim, a Democratic aide said the party also plans to continually bring up the comments in floor speeches and a variety of other media in the coming weeks.


    A GOP aide told Politico, "You can almost see the ads being written already." Other lawmakers also expressed frustration about the line from Trump, according to the report.

    Given the fact that the AHCA has consistently polled dismally, with many polls showing a majority of Americans disapprove of the House bill, the comments from Trump appear to be another concern that the healthcare debate could harm Republicans in the 2018 midterms.

    SEE ALSO: New study says House GOP healthcare bill would lead to the loss of almost 1 million jobs in 10 years

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    chuck schumer

    Senate Democrats plan to go all out in their protest against the GOP healthcare bill starting Monday night.

    Lawmakers in the party plan to use a series of stall tactics to try to draw attention to the way Republicans are writing their version of the American Health Care Act and to protest the policy changes that are expected to be in the bill.

    A Democratic Senate aide told Business Insider the move would consist of four measures:

    1. Objecting to nearly all unanimous-consent requests, which are used to more quickly act on requests or resolutions that have bipartisan support. While this will not prevent any measure from passing, it can slow down proceedings significantly. The Democratic aide said some resolutions would be allowed through, such as a resolution honoring the victims of last week's congressional baseball shooting.
    2. Submitting a series of unanimous-consent requests designed "to attempt to force the House-passed healthcare bill to committee," delay a series of votes on the legislation, "and increase transparency, forcing Republicans to publicly defend their 'no hearings strategy.'"
    3. Using a series of parliamentary procedures "to highlight the difference between the open process used to pass the Affordable Care Act and the process Republicans are pursuing now."
    4. Highlighting healthcare issues "late into the evening in a series of speeches."

    While none of these measures can hold up the bill indefinitely, the Democratic protests would slow down the Senate business and most likely bring more attention to the issue.

    Senate Majority Leader Mitch McConnell and top Republicans are writing the bill in private to avoid intense publicly scrutiny.

    Despite reports suggesting McConnell intends to bring the bill to the floor for a vote by the weeklong July 4 recess, there is no public text, no Congressional Budget Office score, and scant details on what the bill will contain.

    Senate Minority Leader Chuck Schumer said in a statement that the moves were designed to shed a light on the bill and that the secretive process showed Republicans to be "ashamed of it, plain and simple."

    "These are merely the first steps we're prepared to take in order to shine a light on this shameful Trumpcare bill and reveal to the public the GOP's true intentions: to give the uber-wealthy a tax break while making middle class Americans pay more for less healthcare coverage," Schumer said. "If Republicans won't relent and debate their health care bill in the open for the American people to see, then they shouldn't expect business as usual in the Senate."

    While a good number of Senate GOP members have also expressed frustration about the closed-door process being used to create the bill, none have publicly rejected the tactic. In a statement, the Republican National Committee called the move a "pure partisan game aimed at placating the far-left."

    SEE ALSO: New study says House GOP healthcare bill would lead to the loss of almost 1 million jobs in 10 years

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    mitch mcconnell

    Senate Republican leadership is trying to thread the needle in their bill to bridge one of the biggest healthcare divides in the party.

    Axios' Caitlin Owensand The Hill's Peter Sullivan reported Monday that party leadership is attempting to placate both conservatives and more moderate members on the key issue of Medicaid spending. But the top brass seems to favor deeper cuts in the long run.

    Rank-and-file GOP senators have been divided on Medicaid funding since the beginning of the debate over the new healthcare overhaul.

    Some members, especially in states that expanded Medicaid under the Affordable Care Act, want to preserve higher federal funding levels to help maintain access to healthcare for the low-income people Medicaid is designed to help.

    More conservative members have decried the expansion as a new entitlement and believe its funding should be stripped immediately.

    Here are the three big changes being discussed, according to the reports:

    • Phase Medicaid expansion out over three years starting in 2020. That is different than the House bill, which would drop the increase in federal funds for the Medicaid expansion immediately after 2019. It would likely please moderates and members in Medicaid expansion states. 
    • Change the formula for growth in Medicaid spending after 2025. Instead of using the consumer price index for medical costs to formulate the increase, the consumer price index for all goods would be used, which would make spending growth increase at a much slower rate. That would likely appease conservatives who have demanded lower Medicaid spending.
    • States could select the baseline from which to start their Medicaid spending growth, which would help smooth the transition for states that took the expansion.

    The Congressional Budget Office estimated that the House proposed changes would result in 14 million more people going without insurance by 2026 compared to the current baseline. It will be unclear how the Senate's changes would impact that number until a CBO score is released for its version of the legislation.

    SEE ALSO: Democrats plan to bring the Senate to a screeching halt to protest the GOP healthcare bill

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    • Jon OssoffVoters head to the polls Tuesday in Georgia for the most hyped special election in years.
    • The race pits a 30-year-old Democratic political neophyte against Georgia's former Republican secretary of state.
    • It's viewed as the first major referendum on Trump's presidency.

    Voters in Georgia's 6th Congressional District will head to the polls on Tuesday to choose between Jon Ossoff, a 30-year-old Democrat and political neophyte, and Republican and Georgia's former secretary of state, Karen Handel.

    The special election is one of the most anticipated in recent memory. It has seen record-high early-voting turnout and garnered over $51 million in spending, making it the most expensive House race in history.

    It has been billed as the first major referendum on Donald Trump's presidency, and an Ossoff win in a traditionally Republican district could foreshadow a tricky electoral landscape for Republicans in the upcoming 2018 midterm elections.

    "Republicans won a lot of elections when [former president Barack] Obama was in office, and because of that we're playing defense right now," said Chip Lake, a Republican strategist in Georgia and the former Capitol Hill chief of staff. "When you win a lot of elections, you can only pat yourself on the back for so long before realizing you now have to defend those seats you won." 

    Both Ossoff and Handel have drawn high-profile endorsements. Ossoff has support from celebrities like Samuel L. Jackson, Chelsea Handler, and George Takei, as well as from groups like the American Nurses Association and Democracy for America. Handel has drawn extensive support from groups like National Right to Life and the US Chamber of Commerce, and from prominent members of the Republican wing, like House Speaker Paul Ryan, Vice President Mike Pence, and President Trump. 

    Trump recorded a number of voter-outreach calls urging constituents to cast their ballots for Handel, and he has also tweeted about the race several times, drawing attention to key issues like border security and healthcare reform. 

    "The Dems want to stop tax cuts, good healthcare and Border Security.Their ObamaCare is dead with 100% increases in P's. Vote now for Karen H," Trump tweeted Monday. 

    He added Tuesday morning: "KAREN HANDEL FOR CONGRESS. She will fight for lower taxes, great healthcare strong security-a hard worker who will never give up! VOTE TODAY."

    Healthcare takes center stage

    Political strategists say more than anything else, it's likely healthcare will be the defining issue in Georgia's election and into next year's midterms.

    Things like the deficit, environmental protection, and other social issues are important, "but they don't affect voters directly the way healthcare does," said Rick Tyler, a veteran Republican strategist and former spokesman for Texas Sen. Ted Cruz.

    "Everybody gets sick, everybody deals with doctors, everybody sees their rising premiums. It's very real, and people see it come out of their paycheck," Tyler added. 


    Ossoff and Handel have largely adhered to their respective party platforms on healthcare reform. Ossoff has argued in favor of keeping and reforming the Affordable Care Act and for defending access to government programs like Medicare and Medicaid.

    He has also campaigned on protecting women's healthcare providers, like Planned Parenthood, and access to contraception.

    Handel has advocated for a full repeal of Obamacare, calling it "the single biggest intrusion into the lives of Americans in decades." She endorsed the GOP's current effort to repeal Obamacare and said that though it is "a work in progress," it is "on the right track." 

    The GOP's replacement legislation in the House of Representatives, the American Health Care Act, is facing a steep uphill climb amid intense public backlash. After a rocky start, the bill passed the House.

    The Senate is formulating its own version of the legislation, and it has faced increasing backlash in recent days for what has been a relatively secretive negotiating process with no public hearings or discussions on the bill. Severalpolls released in late May found that the bill's latest version was favored by less than one-third of American voters, and a June survey from the left-leaning Public Policy Polling pegged the AHCA at a 24% approval rating.

    The GOP's managing of the Obamacare repeal effort could weigh down Handel and 2018 Republican congressional candidates, strategists said. 

    "I can't imagine it could have been handled any worse by Congress than it already has been," Tyler said, adding that it was "hypocritical" for Republicans to shun transparency on the bill when they criticized Democrats for doing the same during Obama's presidency.

    "Nobody knows what's in the [Republican] plan, and Democrats are really going to capitalize on that," Tyler said. 

    An aide for the Democratic Congressional Campaign Committee said while the race between Handel and Ossoff has been increasingly tight — a number of surveys show them polling within the margin of error — the GOP's healthcare fumble may give Ossoff a critical boost. 

    Healthcare reform may wield particular significance in Georgia's 6th district. Ossoff and Handel are vying for a seat that's open because "the president selected Tom Price, who held the district, for a cabinet position," Lake said. "And not just any cabinet position. He's the Health and Human Services secretary with the sole mission of dismantling Obamacare."

    Those factors, Lake said, culminate in a "tremendous" amount of energy on both sides, but particularly among Democrats. "They see an opportunity to win a race in a Republican district and they've gone all in to do it. Their base is energized, they have the momentum, and that's why this district is competitive."

    jon ossoff karen handel

    'Democrats are angry'

    Trump's combative nature and the controversy surrounding his administration has played a key role in galvanizing the opposition, said Glen Bolger, a longtime Republican pollster and co-founder of the firm Public Opinion Strategies. 

    "Ossoff has been successful because Democrats are angry," Bolger said. "They want to send a message, and they're looking for opportunities because they felt like they let it get away in 2016." 

    But that dynamic is not uncommon, particularly when the White House is controlled by the opposing party. In the 2006 midterm elections during George W. Bush's presidency, Democrats won control of Congress. In 2010, when Obama was in the White House, Republicans took back the House, and they regained control of the Senate in 2014. 

    "Now that the pendulum's swinging back the other way," Lake said, "Republicans are playing defense and Democrats are on the offense."

    Ossoff has a particularly good chance in Georgia because he fits the district he wants to represent, Tyler said.

    "Typical Democratic candidates don't fit southern, suburban districts like this, which is why they lose. But Ossoff is not a typical progressive candidate," he said.

    Ossoff opposes progressive pillars like pushing for single-payer healthcare and increasing income taxes. He has also championed fiscal responsibility on the campaign trail in an attempt to win over more moderate voters and undecideds who lean Republican.

    Democrats may have to put forward more candidates like Ossoff if they want to take back control, Tyler said

    . "They're going to have to recruit candidates who are pro-life, who are fiscally conservative, who defend the Second Amendment. That's just the reality. You can't compete in a district and be 180 degrees out of step with the culture," he said.

    A long road ahead for Republicans

    Strategists say that Republicans are caught between a rock and a hard place, with the situation likely exacerbated by a White House that's been taken off course by mounting controversies and internal strife. Trump has had no major legislative achievements five months into his term, and his agenda has been stalled by a number of congressional and FBI investigations into Russian election meddling and the Trump campaign's possible role in it. 

    Donald Trump

    As the president has grown increasingly agitated and lashed out in response to the ongoing inquiries, congressional Republican candidates like Handel have seen their own numbers take a hit.

    According to an internal GOP poll cited by Politico, increased coverage of the Trump-Russia controversy has coincided with a decrease in Handel's poll numbers. And one private survey, Politico said, saw Trump's approval rating drop from 54% to 45% in the district since February. 

    In what looks like an acknowledgement of Trump's waning popularity in the area, Handel has said that she is not "an extension of the White House."

    Tyler said the Russia controversy could be connected to Handel's decline in the polls because although the 6th district is a traditionally Republican district, it's "a pretty pragmatic and practical district in that they want to see the president and the Republican party move an agenda and get things done."

    If Trump "says things that are destructive to the Republican agenda and he keeps getting distracted by coverage of the Russia story, voters won't like that," Tyler added. 

    To protect their chances against a Democratic onslaught in upcoming elections, Republicans need to focus on their agenda and the president needs to get on the same page as congressional leaders, Bolger said.

    "They need to keep the economy humming along, and the president needs to cut down on the chaos," Bolger said. "There's a lot of uncertainty in the White House, on Twitter, and even in Congress," and that needs to be controlled, he added.  

    As far as Georgia goes, Republicans are typically favored to win the district because it's an open, suburban seat in the South, which is where the party runs strongest.

    "This is important. If we don't win this election, that would be a problem," Lake said. 

    SEE ALSO: 'People are waking up': A key architect of 'Trumpcare' faces hostility back home

    DON'T MISS: Jared Kushner is reportedly looking for new lawyers as the Trump-Russia investigation escalates

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    Democratic Sens. Cory Booker, Brian Schatz, and Chris Murphy decided to take their hunt for the GOP's healthcare bill on the road Tuesday.

    In an attempt to bring attention to the secretive process being used by the Republican Senate leadership, the trio broadcast their hunt for the bill on Facebook Live. 

    The three lawmakers headed over to the Congressional Budget Office to request a copy of the bill since Republicans have not made their plan public, even to some members of their own party.

    Reports suggest that the GOP has submitted at least some parts of their bill to the CBO to get a preliminary score on some of the more important aspects of the bill. Thus, Booker, Schatz, and Murphy decided to try and see if they could get a copy.

    Since the bill text was submitted privately, the CBO is obligated to not release it to the senators — which they likely know — but the Democrats used to opportunity to highlight what they called the "absurd" process Republicans are using to obscure the bill from the public.

    As of this writing, the two livestreamed videos had nearly 60,000 viewers apiece, so despite the likely futility of the exercise, it appears to have attracted some attention.

    Based on the final video, the senators were not able to get the bill from the CBO nor could the CBO confirm they were working on the bill.

    The GOP plans to finalize their bill by Thursday and have a vote on the healthcare overhaul by the end of next week.

    Watch the videos via Sen. Booker's Facebook:



    SEE ALSO: Senate Republicans are getting close to a final Obamacare repeal bill

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    White House Press Secretary Sean Spicer said Tuesday that President Donald Trump wants the Senate GOP's healthcare bill to be compassionate, but he wouldn't say if the president has issues with the current form of the bill.

    "The president clearly wants a bill that has heart in it," Spicer said. "He believes that healthcare is near and dear to so many families and individuals. He made it clear from the beginning that was one of his priorities and he hopes the Senate works through this bill as the House did. Any ideas are welcome to strengthen it, to make it more affordable, more accessible 

    The comments followed a report from CNBC's Eamon Javers that the president told a meeting of tech CEOs Monday that the Senate's version of a healthcare bill needs "more heart."

    Trump also told a luncheon of GOP senators last week that the House's version of the American Health Care Act was "mean."

    When pressed what if the "more heart" comments on Monday meant that Trump had issues with aspects of the Senate law, Spicer demurred.

    "I'm not going to get into private discussions that he's had," Spicer said. "But, the more we can do to produce a bill as it goes through this process that achieves the president's goals, that's something we can all agree on."

    Senate Republican leadership is finalizing the legislative text of the bill, and expects to have a vote on its by next Friday. According to reports, the bill could increase spending from the House version on things like tax credits to help people access insurance, but also make deeper cuts to the Medicaid program.

    Spicer said he did not know if Trump had seen any legislative text of the bill, but did confirm the president had a discussion with Senate GOP leadership on Tuesday and said members of the administration were giving input on the bill.

    The exact details of the healthcare legislation are unclear, as the bill has not been made public.

    SEE ALSO: Senate Republicans are incredibly close to a vote on 'Trumpcare'

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    Sen. John McCain appears somewhat fed up by the process being used to draft the Senate Republican healthcare bill.

    When asked by Bloomberg's Laura Litvan on Tuesday if he had seen the bill, McCain was blunt.

    "No, nor have I met any American that has,"McCain said."I'm sure the Russians have been able to hack in and gotten most of it."

    While McCain may be have expressed his sentiments most colorfully, many Republican senators have expressed frustration with Majority Leader Mitch McConnell's tactics for drafting the bill.

    McConnell told reporters Tuesday that a draft version of the bill would be released Thursday, but so far few members on either side of the aisle have seen any text of the massive legislation.

    That has led to outrage among Democrats and bristling from Republicans. Moderate Sen. Susan Collins, a key swing vote for the bill, also told Bloomberg she had not seen the bill and said the short timeframe would give her little time to analyze it.

    "I’m very eager to see the language,"Collins said. "I don't think it gives enough time to thoroughly analyze the bill, but we’ll see when it comes out."

    Sen. Mike Lee, a conservative member of the working group involved in the bill's creation, said in a Facebook video Tuesday that even he hasn't seen the legislation.

    "Even though I've been a member of this working group assigned to help narrow some of the focus of this, I haven't seen the bill," Lee said. "It has become increasingly apparent over the past few days that even though we thought we were going to be in charge of writing this bill within this working group, it's not being written by us."

    Lee went on to say the bill is being written by a group of staffers in leadership and he is "frustrated" by the lack of transparency.

    With Republicans holding a slim, two-seat majority in the Senate, many policy analysts have suggested it would only take a few members to come out and say they won't vote for the bill to encourage a more open process.

    SEE ALSO: MCCONNELL: Senate GOP healthcare bill coming on Thursday, vote next week

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    doctor-officeA new interactive map reveals who would be most affected by the Republican Obamacare repeal bill, where those Americans live and what the effects would be. It also breaks down which areas stand to be hardest hit by coverage losses, both on a state and county level.

    The map was released first to TPM by The Century Foundation. It assumed the Senate will follow the House version’s model. It assesses the effects all the way out to 2026, period that the Congressional Budget Office assessed in its score of the House bill, the American Health Care Act.

    The researchers took the by-state coverage loss number tabulated by the Center for American Progress, in its analysis of the CBO report, and divided that by the total under 65 population (as those 65 and older are presumably on Medicare). The researchers then divvied up the states into three coverage loss categories—high, medium and low—based on the percentage of population losing coverage, per CAP’s estimates.

    MAP 1: How TrumpCare hurts us all 

    The Century Foundation researchers did the same exercise on the county level. The researchers looked at the 2015 American Community Survey data on county level enrollment in various types of health coverage and followed CAP’s model on how those populations would be affected by the American Health Care Act. The coverage losses were divided by the total under 65 county population, and those with higher percentages of coverage losses were distinguished accordingly.

    MAP 2: How TrumpCare hurts us all — county level

    The maps also show how many total people are on the Obamacare exchanges, Medicaid, employer plans and Medicare. The accompanying Century Foundation report outlines how all of those coverage programs stand to be affected by the House bill.

    SEE ALSO: Americans overwhelmingly like Obamacare more than Trumpcare

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    Senate Majority Leader Mitch McConnell told reporters Tuesday that the Senate GOP's healthcare bill will be released on Thursday and a vote will come as soon as next week.

    The move had long been speculated, but McConnell's confirmation sets the upper chamber on a fast track for a huge vote.

    McConnell said that the vote will happen as soon as the Congressional Budget Office releases its report on the bill, which should be some time next week.

    Legislative text should begin to be shown to rank-and-file Republicans by the end of the week, before the vote next. The limited timeframe means that there will be little time for debate, which has been a source of contention for both Democrats and a number of GOP members.

    A vote late next week will also be perilously close to the self-imposed deadline. McConnell wants to get a vote done by the week-long July 4 recess in order to avoid further public scrutiny on the bill.

    "I believed the majority leader when he said he's going to take it up," GOP Sen. Richard Burr told Politico on Monday."I expect us to vote on it next week."

    Sen. Bob Corker said on MSNBC Tuesday that GOP senators will be meeting on Wednesday to outline the bill and the language will be distributed on Thursday. He also said he had not seen the plan yet.

    There are some caveats, however, as Republicans have to come together on a few key issues in order to meet this timeline.

    Hurdles and delays

    For instance, the two sides disagree on how long to fund the Affordable Care Act's Medicaid expansion, which increased the limit for Medicaid to income equaling 138% of the federal poverty limit. Many Republican-majority states have expanded the program that provides insurance for low-income Americans, compelling Senators in those states to try and preserve the expansion. Conservative, on the other hand, want to get rid of the increased federal spending as soon as possible.

    While the outline of a plan for Medicaid appears to be forming, it is far from guaranteed that the idea will placate both sides.

    Other issues such as the size of tax credits to help people buy insurance, waivers that would allow states to do away with some of the ACA's consumer protections, money to fight the opioid crisis, and the need to repeal some of Obamacare's taxes will come into play during the negotiations.

    Not only do Republican Senators face a series of complex issues, the path forward is complicated by the fact that McConnell can only afford to lose two members of his conference. Any more than that and the bill will fail.

    According to Politico, these disagreements could still kill or delay the bill past the self-imposed deadline.

    The other possibility is that the GOP knows they do not have enough votes to pass the bill and bring it to the floor anyway. This would allow them to put the issue to rest and move on with other items on the agenda — like tax reform.

    The final issue is the score from the Congressional Budget Office.

    The CBO score is necessary since the Senate bill must save as much or more against the federal deficit than the House of Representatives version.

    The GOP leadership has been sending bits and pieces of the bill to the CBO in order to get preliminary scoring on the bill, but it's unclear how soon the bill needs to get to the CBO in full in order to guarantee a vote by next Friday.

    Additionally, the House's bill showed that 23 million fewer people will have health insurance by 2026 than under the current system. If the Senate bill is just as bad, or worse, it could deter some Senators from voting for the bill.


    SEE ALSO: Republicans may have a plan to solve their biggest healthcare disagreement

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    Obamacare's insurance exchanges are facing a big day Wednesday.

    June 21 marks the deadline for insurance companies to indicate interest in the Affordable Care Act's individual insurance exchanges for 2018, submitting their first proposals for individual insurance offerings next year.

    Insurers' actions at the deadline represent a barometer for the health of the market.

    Insurers' decisions could affect insurance coverage and healthcare costs for the more than 10 million Americans currently enrolled in the marketplaces.

    Perhaps most significant, insurers will need to decide on their participation. If insurers abandon the markets, it could lead to a worst-case scenario in which a large swath of the US faces the reality of having no insurer in the market for those lacking coverage through their employer or a government program like Medicare.

    Cynthia Cox, the associate director at the Kaiser Family Foundation, a nonpartisan health-policy think tank, said states could persuade insurers to enter the market later even if there were counties with no insurers for the individual market after Wednesday's deadline.

    "It's theoretically possible the administration could be flexible with the deadline if there isn't sufficient interest in a given state," Cox told Business Insider in an email. "There is also still time for insurers to negotiate on rates and participation within states. Insurers have until early fall before they have to commit one way or the other."

    So far this year, there has been a slew of bad news for the exchanges in terms of insurer participation. The large, publicly traded insurer Aetna ditched all of its Obamacare business in May, and Anthem pulled out of Ohio, leaving up to 20 counties in that state without an insurer for their individual exchange next year.

    Over the past week, however, some stabilization has come to states, with Washington gaining an insurer for one of its bare counties and Medica deciding to remain in Iowa.

    Another factor to watch is the size of premium increases that insurers request.

    Large premium hikes over the past few years have been a political flash point, with President Donald Trump railing against them during the 2016 presidential campaign.

    While many health-policy experts said the steep rate hikes in 2016 were a one-off to correct for previously underpriced plans, recent indications from state-run exchanges have predicted even higher premium increases even as many insurers near profitability.

    "Last year's rate increases were roughly enough to get premiums back to a sustainable level, and in a stable policy environment, the market would have been poised for a return to more moderate increases this year," said Matthew Fiedler, a fellow with the Center for Health Policy in the Brookings Institution's Economic Studies Program. "But actions by the administration and Congress around the mandate and CSRs have made that impossible."

    The future of the individual insurance landscape under the Affordable Care Act has never been murkier, with Congress nearing a repeal-and-replace bill for the ACA.

    The Trump administration has been extending CSRs, or cost-sharing reduction payments, on only a month-by-month basis. CSRs are government payments to insurers designed to offset the cost of offering reduced out-of-pocket payments to low-income Americans. The White House's refusal to commit to the CSRs indefinitely has left insurers without a guarantee the payments will continue.

    It is also unclear whether the administration will maintain the mandate that all Americans purchase health insurance, another feature of the Affordable Care Act designed to offset costs to insurers.

    (Read more about the cost-sharing reduction payments»)

    "Without clarity on cost-sharing subsidy payments and individual mandate enforcement, insurers are making a variety of assumptions, in some cases raising rates by 20 percentage points or more above what they otherwise would have," Cox told Business Insider.

    For instance, Blue Cross Blue Shield of North Carolina asked for a 22.9% increase for 2018 but said it would have asked for only an 8.8% increase if it were given clarity around the CSR payments.

    According to Fiedler, insurers have gotten more transparent in their reasons for cost increases. At first they merely cited "uncertainty" as reasons for the premiums hikes, but recently insurers in states have broken out exactly how much the CSR issue has driven up the costs.

    "In terms of insurers' posture, there has been a shift in insurers' posture in recent weeks toward highlighting the role of policy uncertainty in driving their requests for large increases," Fiedler said.

    SEE ALSO: MCCONNELL: Senate GOP healthcare bill coming on Thursday, vote next week

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    The American Health Care Act is shaping up to be the least popular legislation in decades, as the Senate prepares to release its own version of the healthcare legislation.

    A poll published Wednesday from Morning Consult and Politico is another in a slew of recent polling showing that the Republican healthcare bill as passed by the House is deeply unpopular. The latest survey displayed 30% approval among respondents and 50% disapproval.

    That represented a collapse from the 42% approval and 37% disapproval levels the bill had when Morning Consult/Politico ran a poll on April 30, before the bill passed.

    While the bill is predictably unpopular with Democrats, independents and Republicans are even turning against it. In April, 67% of Republicans said they supported the AHCA, with just 16% opposing it. Now, just 56% say they favor it, while 30% say they're opposed. Disapproval among independents has also increased in that timeframe from 36% to 53%.

    Screen Shot 2017 06 21 at 9.47.21 AM

    The change may not be a surprise, given that President Donald Trump also swiped at the bill recently. He called it "mean" during a meeting with senators last week, even though he celebrated the AHCA's passage during a ceremony in the White House Rose Garden.

    An analysis from The New York Times on recent AHCA polling showed that there is not a single state in which the bill has even a plurality of support.

    Based on that analysis, the highest approval rating for the bill is in Oklahoma at 38%. But even there, 45% of people in the state are opposed to it. In 25 states, more than 50% of the population disapproves of the House GOP healthcare legislation, according to the Times.

    A chart from Chris Warsaw, an assistant professor for political science at MIT, showed that the AHCA is the least popular major piece of legislation going back to 1990.

    Based on an aggregate of polling from the Roper Center public opinion data, Warsaw said the AHCA is less popular than Obamacare, the Troubled Asset Relief Program (the bank bailout), the Dodd-Frank regulations, President George W. Bush's tax cuts, and even the failed healthcare plan from President Bill Clinton.

    SEE ALSO: Obamacare faces one of its biggest days yet

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    Anthem, one of the five biggest insurers in the US, is pulling out of the Obamacare insurance exchanges in Wisconsin and Indiana.

    In an announcement Wednesday, the company said a combination of decreasing participation in the exchanges and political uncertainty made the company's presence in the two states no longer viable.

    "Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost sharing reduction subsidies and the restoration of taxes on fully insured coverage," Anthem said in a statement provided to Business Insider.

    Wisconsin and Indiana are the second and third states, respectively, from which Anthem has pulled out recently, following its decision to stop offering plans in Ohio earlier in June.

    In comparison to Ohio, Anthem's exit from Indiana and Wisconsin will not leave any areas with no insurer, said Cynthia Cox, associate director at the Kaiser Family Foundation, a nonpartisan health policy think tank.

    The insurer will continue to offer off-exchange individual health insurance plans in one county in Wisconsin and five counties in Indiana.

    Anthem's statement follows a familiar pattern from other insurers who have announced large premium increases or exits from the markets. The statement notes not only the difficult participation circumstances in the market, but also uncertainty in Washington — like the potential discontinuation of cost-sharing reduction payments— that could be a serious blow to their bottom line.

    Opponents of the Affordable Care Act were quick to pounce on the news, with Wisconsin Gov. Scott Walker, a Republican, releasing a statement just a few minutes after the news broke.

    "Growing uncertainty in the health insurance market was created by Obamacare’s costly regulations and it is causing higher premiums and a lack of options," Walker said in a statement. "If we do nothing, more companies will back out and more people will lose coverage. Wisconsin families expect and deserve better health care coverage options and the time to act is now."

    Anthem's statement also said the company was still working with regulators in other states to continue participation in their exchanges. Wednesday is the deadline for insurers to submit their intention to stay in exchanges in states that use the platform.

    "Our commitment to members has always been to provide greater access to affordable, quality healthcare, and we will continue to advocate solutions that will stabilize the market and allow us return to a more robust presence in the future," Anthem said. "In those states where Anthem has not yet made a final participation decision, we continue to work with regulators and remain actively engaged in dialogue."

    SEE ALSO: Obamacare faces one of its biggest days yet

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    Doctor and patient organizations have some thoughts on what they'd like to see out of healthcare reform currently being drafted by a group of Senators. 

    In May, the House of Representatives voted in favor of the American Health Care Act, the GOP's Obamacare replacement plan. At the time, many groups spoke out against the bill.  

    Now, lawmakers in the Senate are working to draft their own bill. Little is known about what will be included with it, and doctors and patients organizations haven't had as much of a chance to share their thoughts on the legislation as they did under the ACA. 

    The Senate bill is set to be released on Thursday. Here's what doctors and patient groups would like to see in it. 

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    American Academy of Pediatrics — "Any new health care policies must increase the number of children with access to comprehensive and affordable health insurance."

    The organization, which represents 66,000 pediatricians, has been against the AHCA since March

    Simply, the AAP would like to see healthcare reform that covers more children. 

    "Any new health care policies must increase the number of children with access to comprehensive and affordable health insurance," the AAP wrote in a letter to Senator Orrin Hatch. 

    That means increasing coverage to parents, specifically through the expansion of Medicaid that was part of the ACA.

    The AAP along with other groups also created a checklist of what healthcare reform has to cover to satisfy them.



    American Lung Association and a coalition of patient groups - Healthcare reform should provide adequate coverage.

    Back in March, the American Lung Association and other patient groups laid out three main principles for what they'd like to see come out of healthcare reform: affordability, accessibility, and adequacy. While the first two terms are pretty straightforward, the "adequacy" component refers to making sure that basic healthcare needs are covered, such as patient visits, hospitalizations, and prescriptions. 

    The coalition of other patient groups that includes: the American Cancer Society Cancer Action Network, the American Heart 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.

    That's been hard to communicate since the groups haven't had a chance to voice their opinions to the lawmakers. 

    "You're never going to get everything right," Erika Sward, the assistant vice president of national advocacy at the ALA told Business Insider. But when you completely exclude patient organizations from the conversations, "you're more likely to get it wrong," she said. 

    American College of Physicians — "Expand access and coverage."

    The organization, which represents 148,000 internal medicine physicians and medical students, opposes the AHCA bill and isn't too happy about the lack of transparency in the Senate. 

    In a 16-page document, the ACP outlined what they'd like to see out of healthcare reform. Here's the short version:

    1. Expand access and coverage
    2. Bring greater value for the dollars spent
    3. Reduce the crushing administrative burden on physicians and patients
    4. Leverage technology to improve patient care
    5. Support a well-trained physician workforce
    6. Reduce barriers to care for patients with chronic diseases
    7. Support scientific research and policies to improve public health

    See the rest of the story at Business Insider

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