Montana Gov. Steve Bullock and Louisiana Gov. John Bel Edwards, both Democrats leading deeply conservative states, warned that the cuts to Medicaid proposed in the GOP's Senate healthcare bill would devastate thousands of their states' most vulnerable residents. 

Both governors welcomed increased federal funding for Medicaid under the Affordable Care Act (commonly known as Obamacare) and argued on a call with reporters on Wednesday that Republican lawmakers should "throw out" their bill, called the Better Care Reconciliation Act, and restart discussions in a transparent, bipartisan way, with a focus on lowering costs and improving stability in the private insurance market. 

Both governors said the proposed Medicaid funding cap would not only strip coverage from needy individuals, but throw their states into fiscal distress. 

"The budget uncertainty that this forces on states is just simply unsustainable," Edwards said. "We need more predictability, more stability." 

They argued that the program, which provides health insurance to low-income individuals, including children and people with disabilities, is effective and popular, even among conservative residents. 

"Every time that someone in Washington says, 'well, the Affordable Care Act isn't working,' they're inevitably talking about the markets," Edwards said. "But they never really point to the Medicaid program because the Medicaid program is working the way it was supposed to." 

Since Edwards made Louisiana the 32nd state in the country to expand Medicaid last July, 430,000 residents have gained insurance and the uninsured rate has dropped from 21.7% in 2013 to 12.7% as of February 2017. 

"We are literally saving lives," Edwards said. "We have hundreds and hundreds of people diagnosed with cancer and they're being treated — they wouldn't have known but for the fact that they now have Medicaid. You take that away and we can say with certainty people will die."

If the proposed Medicaid spending cap is enacted, Edwards said Louisiana would lose "$14 billion worth of health care" between 2020 and 2026. He argued that the states can afford to pay the 10% Medicaid cost match that it would under Obamacare, but could not bear the burden of a reduction in federal funding.

Louisiana and Montana both rank among the country's poorest states.

Bullock argued the GOP bill would "disproportionately affect" rural states like Montana in part because a significant number of rural hospitals and health providers rely on Medicaid reimbursements to remain financially viable. 

"Our's is a state of a million people, 147,000 square miles," Bullock said. "If you lose a hospital, you could have to go well over an hour to get to a healthcare facility." 

Recent national polling shows that most Americans, including a majority of Republicans, disapprove of cuts to Medicaid.

The governors argued that support for the program is also bipartisan among party leaders. 

"What Steve and I are saying today is the exact same thing that Charlie Baker is saying in Massachusetts, that Gov. Ducey's saying down in Arizona, that Kasich is saying in Ohio, and Sandoval is saying in Nevada," Edwards said, naming Republican governors who oppose Medicaid cuts. "It's not whether you're Republican or Democrat, it's whether you've seen the benefits of the Medicaid expansion."

On Tuesday, Senate Republican leaders unexpectedly delayed a vote on the GOP bill in an effort to renegotiate its terms and gain more support from more moderate and conservative party members. 

'Health care is too expensive': bipartisan reform 

While both governors had harsh words for the GOP bill, they insisted that they support bipartisan reform efforts, specifically those that focus on the private insurance market.  

"We can all certainly agree that health care is too expensive," Bullock said. "Instead of gutting Medicaid, a program that works, we should be focused on what we can all agree on: we need to bring down costs and we need to bring stability to the marketplace." 

One obvious way to bring down costs, Edwards argued, would be to use the "purchasing power" of Medicaid to negotiate drug prices with pharmaceutical companies. 

"That would save a tremendous amount of money each year," Edwards said, noting that rising drug prices account for a large portion of Medicaid's increasing costs. "That's a step, right away, that could be taken, but it's not in the bill either."

The governors reiterated their support for expanding employer-sponsored insurance to individuals who are not currently covered by their employers, improving affordability in the private insurance market, reforming regulations on insurance companies, and allowing the states more flexibility in implementing the law.

Both Bullock and Edwards were elected on pro-Obamacare and Medicaid-expansion platforms, which have received bipartisan support in the states. 

Edwards said that he has "a good working relationship" with one of his state's Republican senators, Bill Cassidy, who introduced an Obamacare replacement with moderate Republican Sen. Susan Collins in January that would have kept much of the law in place.  

"I'm hopeful that Senator Cassidy, especially, will be very influential in hopefully throwing out the bill that's presently under consideration and starting over," Edwards said. 

Bullock and Edwards both signed on to a June letter to Senate Majority Leader Mitch McConnell and Minority Leader Chuck Schumer, with a group of seven Democratic and Republican governors, asking the leaders to work together on the healthcare bill.

The governors wrote, "While we certainly agree that reforms need to be made to our nation’s health care system, as Governors from both sides of the political aisle, we feel that true and lasting reforms are best approached by finding common ground in a bipartisan fashion."

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During a meeting of Republican senators and President Donald Trump at the White House on Tuesday, Sen. Dean Heller tried to lighten the mood.

The Nevada senator made reference to ads from a pro-Trump nonprofit group attacking him for opposing the Senate GOP's healthcare bill. He joked, according to The Washington Post, that the ads should have used his real face instead of actor Matt Damon.

While a few members of the meeting laughed, the moment also offers a crystallization of Trump's approach to passing the Senate healthcare bill.

Heller is up for reelection in 2018 in a state that Hillary Clinton won in the presidential election. The popular governor of the state, Brian Sandoval, has opposed the Senate healthcare bill, and the cuts to the state's Medicaid program would be among the worst in the country.

Given this political reality, Heller came out strong against the bill last Friday.

Within days, the pro-Trump group, America First Policies, made ads attacking Heller for his position and pressuring him to support the bill. 

Senate Majority Leader Mitch McConnell was not pleased with the ads, according to the Post, and called White House Chief of Staff Reince Priebus to express his displeasure.

The disconnect over Heller wasn't the only misstep for which the White House has been criticized during the run-up to McConnell delaying a vote on the bill until after the week-long July 4 recess.

Multiple accounts have suggested Trump did not have a solid grasp of the basics of the Senate GOP's bill during the meeting, and some Republican senators, aides, and lobbyists have questioned the amount of influence Trump has on the process.

The White House has also been publicly touting that the bill does not cut Medicaid — to little avail, since moderate GOP senators have cited the cut to future spending growth as a major reason to oppose the bill. Trump himself tweeted the claim on Wednesday night.

The attacks on Heller, however, seem to be a key point of discomfort for Republican senators concerned about the political cost of voting for a bill that the Congressional Budget Office projected would leave 22 million more Americans without insurance in 2026 than under the current system.

SEE ALSO: TRUMP: We're going to have a 'big surprise' on healthcare

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House Speaker Paul Ryan on Thursday suggested opponents of the Republican healthcare proposals are going too far in their criticism.

"The rhetoric is just over the top," Ryan told local Wisconsin radio station WISN. "I have seen a lot in my day and this rhetoric, it's hysterical, it's hyperbolic. It's really something."

Ryan also said much of the complaints from Democrats seems to stem from their losses in special elections for House seats in Montana, Georgia, South Carolina, and Kansas.

"I think they're really upset because they lost all these special elections we've been having and resist is not inspiring," Ryan said, according to a transcript from the Associated Press' Erica Werner.

Democrats' criticism has centered on the Congressional Budget Office projections that the Republican healthcare bills in the House and Senate would leave over 20 million more Americans respectively without healthcare coverage in 2026 than under the current system.

Ryan also took issue with rhetoric suggesting people could die if Republican bills are passed into law, claims that have been advanced by the likes of Sen. Bernie Sanders and former presidential candidate Hillary Clinton. 

Ryan said the claims were inappropriate, especially so soon after the shooting of House Majority Whip Steve Scalise.

"We almost lost Steve that day and it was really really close for 48 hours there and he's a really close friend of mine," Ryan said. "Let's all fight with civility and respect for the beliefs and causes we believe in but let's be civil with one another. ... And accusing people who are trying to solve a healthcare problem of trying to kill people is not having a civil debate."

The healthcare push is currently stalled in the Senate, as moderate and conservative members have not been able to come to an agreement on key provisions of a bill to advance it for a floor vote this week.

SEE ALSO: GOP senator's joke about Matt Damon shows how Trump's push on the healthcare bill went wrong

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Lawmakers like to make comparisons for different aspects of the legislative process, but Sen. Pat Roberts broke out a new one for the Senate Republican deliberations over their healthcare bill.

Moderates and conservatives are stuck at an impasse on the bill, the Better Care Reconciliation Act, and are attempting to find a compromise. When asked if the two sides could come together on a bill, Roberts, a Republican from Kansas, used a rather prickly wildlife analogy.

"Even porcupines make love," the Kansas Senator said.

Later, Roberts expanded on his comments.

"Once in Glacier National Park I saw two porcupines making love," Roberts told reporters. "I'm assuming they produced smaller porcupines. They produced something. It has to be done carefully. That's what we're doing now."

Senate Majority Leader Mitch McConnell is working with the two disparate sides of the conference to try to come to an agreement on the bill. Increased funding to fight the opioid crisis, preserving some of Obamacare's taxes, and changes to Medicaid funding cuts are all being discussed in the attempts to bridge the divide.

It's unclear if porcupines are involved.

SEE ALSO: GOP senator's joke about Matt Damon shows how Trump's push on the healthcare bill went wrong

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In an attempt to break the Senate GOP's stalemate over their healthcare bill, Sen. Ted Cruz is pushing a plan that could end up further complicating the discussions.

Cruz has put forth an amendment for the bill, the Better Care Reconciliation Act (BCRA), that would allow insurers to sell plans that do not follow regulations created in the Affordable Care Act, or Obamacare. To do so, insurers would have to maintain at least one plan that would adhere to the regulations.

That would allow insurers to offer plans that skimp on coverage but have lower costs. Theoretically, such deregulated plans would be more attractive to young and healthy people who do not want the full suite of coverage options.

The two main regulations that the Cruz plan would let insurers avoid are essential health benefits (EHBs) and community rating.

EHBs are a set of 10 types of care that all plans have to cover under Obamacare, including maternity care, mental health care, and emergency room trips.

Community rating is a provision of Obamacare that requires people of the same age in a given area to be charged the same amount for premiums. In practice, that means people with preexisting conditions can't be charged more than those who are healthy. That raises prices for healthy people, but it also prevents sick people form paying drastically higher prices or being priced out of the market altogether.

For this reason, the Cruz plan might not be politically viable.

The idea would likely win over some more conservative senators that oppose the current BCRA, like Mike Lee of Utah and Ron Johnson of Wisconsin.

Conservative groups also praised the idea, saying it follows through on Republican commitment to repeal Obamacare.

"It is encouraging to see Senate leadership exploring the merits of serious proposals that would inject much-needed consumer choice and competition into an otherwise deteriorating market," Heritage Action CEO Michael Needham said in a statement Thursday. "These are the types of reforms that would help roll back the damage inflicted by Obamacare. Simply throwing more money at the problem as some moderates are seeking to do is not an enduring solution."

On the other side, preexisting condition protections are a non-negotiable for many more moderate GOP senators.

"If Cruz succeeds in putting it in the bill, the bill dies. Period. End of sentence, end of paragraph, end of story," a senior GOP aide told Axios' Caitlin Owens.

According to Axios, the aide said the bill would lose between 20 and 30 votes if Cruz's amendment is added.

A spokesperson for Cruz did not immediately respond to a request for comment.

SEE ALSO: GOP senator's joke about Matt Damon shows how Trump's push on the healthcare bill went wrong

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President Donald Trump appears to be losing faith that the Republican-controlled Senate can pass a healthcare bill.

"If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!"Trump tweeted Friday morning.

It was not the first time the president had suggested that the Republicans' latest bid to overhaul the US healthcare system may not succeed.

Trump met with Republican senators on Tuesday, just hours after Majority Leader Mitch McConnell delayed a vote on the party's healthcare bill, saying that if it didn't pass, he would "understand."

"This will be great if we get it done," Trump said. "And if we don't get it done, it's just going to be something that we're not going to like. And that's OK, and I understand that very well."

The GOP Senate conference is at an impasse on the bill, named the Better Care Reconciliation Act.

Moderate senators believe the bill goes too far with its funding cuts to major programs like Medicaid. Conservative senators, on the other hand, believe that the bill does not cut enough funding or peel back enough of the Affordable Care Act's regulations.

The two sides held meetings over the past two days to resolve the differences, but no agreement has been reached.

McConnell wanted to get a deal done by Friday so the new version of the bill could be scored by the Congressional Budget Office over the weeklong July 4 recess and voted on when Congress reconvenes.

According to reports, however, Senate Republicans sent the CBO a few broad brush strokes to evaluate but did not come to an agreement on a finalized bill.

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Senate Republicans have released their version of a plan to repeal and replace Obamacare.

The Senate's plan, like one passed by the House of Representatives, rolls back many of the provisions of Obamacare, including taking deep cuts from Medicaid program.

 To get a better sense of what that would mean on a state-by-state basis — and who might be hardest-hit by a rollback — we charted out some of the key aspects of Medicaid and the expansion under the ACA.

As of 2017, 31 states and Washington, D.C. adopted the Affordable Care Act's Medicaid expansion. 

Through that expansion, millions have gained coverage. Here's a look at the rate of enrollment per 100,000 people of adults in each state who gained coverage under the expansion in the first quarter of 2016 alone.

The bill also scales back federal funding for Medicaid — which is more than half the spending for the program at the state level. 

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Senate Republicans are making are taking a second crack at their healthcare bill, but it's unclear if proposed compromises will be enough to get the bill across the finish line.

Members of the conference have been meeting constantly since Majority Leader Mitch McConnell delayed a vote on the bill, the Better Care Reconciliation Act, until after the week-long July 4 recess.

Reports have suggested a slew of ideas bandied about to bridge the divide between centrist members of the party and more conservative members, but an agreement has yet to be reached.

Republican leaders sent the Congressional Budget Office the outline of a new bill to get preliminary feedback on the ideas when they get back from recess. That would likely speed up the CBO's process when Senate leaders send a full bill.

While sending something to the CBO is a minor victory for a divided party, the biggest policy disagreements still need to be hammered out. Moderates are demanding more funding for various healthcare initiatives, while conservatives want to gut funding even more and repeal more of Obamacare's regulations.

Here's a rundown of the ideas being discussed:

• More funding to fight the opioid crisis: The BCRA included $2 billion to fight the growing crisis, much lower than GOP senators from states hit hard by the crisis were hoping. Discussions have included raising the funding level to $45 billion. That would be a carrot for moderates like Rob Portman of Ohio and Shelley Moore Capito of West Virginia.
• Allow insurers to sell plans that do not follow Obamacare's regulations: Sen. Ted Cruz has proposed an amendment appealing to the conservative wing that would allow insurers to offer plans that did not qualify under Obamacare's essential health benefits and community rating provisions, as long as they maintained at least one plan that did qualify. That would allow young and healthy people to buy skimpier plans that cost less while maintaining high quality, more expensive plans for those that needed them. But the community rating provision prevents people with pre-existing conditions form being charged more, so a change has faced resistance.
• Keep some of Obamacare's taxes: Senators are discussing leaving some of the taxes included in Obamacare in place, potentially freeing up more funding for programs like Medicaid and the opioid crisis. The biggest could be the 3.8% net investment income tax on people incomes of more than $200,000 a year.
• Expand the use of health savings accounts: A discussion among GOP senators would allow these nontaxable accounts to be used toward premiums.

Whether or not those changes would be enough to get 50 senators on board is unclear. Cruz's proposal would face resistance from moderate members who saw the public backlash after the House included a proposal that would've allowed states to gut preexisting conditions protections.

"If Cruz succeeds in putting it in the bill, the bill dies. Period. End of sentence, end of paragraph, end of story,"a GOP aide told Axios.

Senate leaders also want to expand funding for various proposals to cut down the number of people the CBO projects would be without insurance under the BCRA. Monday's CBO score showed 22 million more Americans would go without insurance by 2026 than under the current baseline. Of those, 15 million would come off the Medicaid rolls, according to the report.

On the other hand, leaving some of the taxes in place or upping the spending on Medicaid and the state stability fund included in the bill might be non-starters for conservatives like Sen. Rand Paul of Kentucky.

Greg Valliere, chief strategist at Horizon Investments, said the longer the disagreement continues on the bill, the more likely it is to fail.

"It's too early to declare the bill dead, but it's on life support," Valliere told Business Insider in an email. "The longer it lies in the July sun, rotting like a dead fish, the more difficult it will be to win public support."

But Valliere said "the wily McConnell will keep dealing until the August recess; if there's no compromise by then, the dance will be over."

Getting the two sides to an agreement soon is paramount to finish the push before the month-long August recess.

Once Congress returns from the summer break, it will have just one month to deal with raising the nation's debt ceiling, moving a funding bill to keep the government from shutting down, and a slew of other necessary legislation.

SEE ALSO: GOP senator compares healthcare deliberations to '2 porcupines making love'

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President Donald Trump shot off a quick tweet on Friday morning that could have serious policy ramifications for the Republican fight to repeal and replace the Affordable Care Act.

"If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!"Trump tweeted.

After leadership earlier this week shelved a planned vote on Senate healthcare legislation, moderate and conservative sides of the Senate GOP conference have been trying to reach an agreement on how to move forward. The impasse leaves doubts on whether anything on the healthcare front will be done before the monthlong August recess.

Trump and other GOP figures now appear to be floating the "repeal first" method in earnest. Sen. Ben Sasse suggested the idea during an appearance on "Fox and Friends"— minutes before Trump's tweet — and he reiterated his support for it after Trump appeared to endorse the plan.

"Glad you agree, Mr Pres. If no agreement next [week], 2 steps: 1. Repeal 1st; then 2. Spend August full-time on replace,"Sasse tweeted.

Sen. Rand Paul also threw his support behind the strategy in a tweet Friday morning.

"I have spoken to @realDonaldTrump & Senate leadership about this and agree. Let's keep our word to repeal then work on replacing right away," the Kentucky senator said.

It's unclear whether a larger swath of the Senate Republican conference would be on board with the idea.

Caitlin Owens of the news website Axios reported that three GOP aides said a strategy of repeal and then replace would be dead on arrival. One said the strategy would get "15 votes," and another said its chances were "zero."

Incidentally, the strategy to repeal first and replace later was an original plan of GOP leadership— until Trump got involved.

Majority Leader Mitch McConnell and others wanted to pass a bill that set a deadline for repealing the ACA, better known as Obamacare, a few years down the road, allowing Republicans ample time to put together a replacement strategy. But senators like Paul urged Trump to shift the party away from that plan.

"I just spoke to @realDonaldTrump and he fully supports my plan to replace Obamacare the same day we repeal it. The time to act is now," Paul tweeted on January 6.

Trump also has repeatedly said he wants a "simultaneous" repeal and replace.

"We're going to be submitting, as soon as he is approved, we'll almost simultaneously — shortly thereafter — have a plan," Trump said at a press conference on January 11. "It will be repeal and replace. It will be simultaneously."

SEE ALSO: It's 'rotting like a dead fish': Senate Republicans are trying to revive a healthcare bill 'on life support'

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NOW WATCH: Listen to the leaked audio of Australia's prime minister mocking Trump

President Donald Trump got elected in no small part because of a signature pledge during the final months of the presidential campaign: to repeal and replace the Affordable Care Act.

In campaign rallies, he attacked on President Barack Obama's signature healthcare law mercilessly. He whipped crowds into a frenzy with his vow to halt the increase in premiums and insurer exits from the marketplace.

"Job-killing Obamacare is just one more way the system is rigged!" he said during an October campaign rally.

Trump promised to repeal the law on "day one." Fives months into his presidency, healthcare overhaul is proving more complicated for Trump than the rhetoric.

And a big part of the blame for the sluggish effort appears to lay squarely on Trump's shoulders. He has contradicted his own party's leadership, over-promised, and distracted from his own agenda. Analysts and frustrated members of his own party say he has helped increase the possibility that the law he railed against for so long stays in place.

Promises he can't keep

On the campaign trail and after his election victory, Trump made grandiose promises about the end result of the Republican healthcare bill.

In interviews before and after the election, Trump promised to cover "everyone" under his Obamacare replacement. He promised that costs for people would come down, that the government would pay less, that no one with a preexisting condition would be denied coverage. He also vowed robust competition in the insurance marketplace.

That defined the debate in Obamacare's terms. Instead of talking about free-market principles, as Republicans had for years whe advocating for the ACA's repeal, the debate was framed around how many people would maintain coverage. Instead of talking about streamlining the market, Trump suggested it needed to become even bigger.

"It's going to be — what my plan is is that I want to take care of everybody," Trump said in an ABC interview right after he took office. "I'm not going to leave the lower 20% that can't afford insurance."

The president even promised not to touch entitlements, including Medicaid. Any repeal of Obamacare, however, inevitably would have to deal with the ACA's expansion of the Medicaid program.

The results haven't been pretty. Based on projections from the Congressional Budget Office, the Senate's bill would slash Medicaid funding, increase the number of uninsured to 49 million in 2026, raise costs for older and sicker Americans, and increase deductibles.

Course corrections

Soon after the election, an idea from Republican leadership emerged: Pass a law that would set a deadline for the repeal, possibly after the 2020 election, and give members a few years to work out a replacement bill.

Trump, however, insisted that the repeal and replace should happen "simultaneously." And he said he wanted it done as soon "a few weeks" after he took office.

In doing so, he prompted a course correction that forced repeal and replace into one bill and getting it passed as soon as possible.

Sen. Susan Collins of Maine, a more moderate member of the GOP conference, expressed frustration about Trump's decision after leadership delayed a vote on the chamber's legislation.

"This president is the first president in our history who has had neither political nor military experience," Collins said. "Thus, it has been a challenge to him to learn how to interact with Congress and how to push his agenda forward. I also believe it would have been better had the president started with infrastructure, which has bipartisan support, rather than tackling a political divisive and technically complicated issue like healthcare."

Now, after insisting on speed and a concurrent replacement, Trump is floating the idea of delaying the process.

"If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!" Trump tweeted Friday, reversing his previous roadmap.

But there no longer appears to be any appetite for that process. According to Axios' Caitlin Owens, a senior GOP aide said there was "zero" chance a full repeal and then replace process could happen in the Senate.

There may be no broad support, but it could embolden conservative holdouts like Sen. Rand Paul to hold their ground. Paul tweeted his support for Trump's idea on Friday. Another GOP aide told Axios that the rapidly changing statements from Trump could slow everything down.

"Not really seeing anything happening in July if this keeps up," the aide said.

'Mean'

Two serious political missteps from Trump and his team have damaged the Obamacare repeal process and allowed Democrats to take advantage.

The first came during a White House meeting about the healthcare push with Republican senators.

Trump called the House's version of the healthcare overhaul "mean." Weeks later, during a Fox News interview, he confirmed he used the term.

That has become a rallying cry for Democrats, who are already preparing to use the comment in ads against Republicans running in the 2018 midterms elections.

And during the Senate's negotiating process, the decision by a pro-Trump nonprofit group to run ads attacking GOP Sen. Dean Heller for his initial opposition mystified party leaders including Senate Majority Leader Mitch McConnell. Heller, up for reelection next year in Nevada, a state which Hillary Clinton won in 2016, is supportive of Obamacare's Medicaid expansion.

McConnell was reportedly annoyed at the ads and called White House Chief of Staff Reince Priebus to tell him they were "beyond stupid." Heller even reportedly made a joke about the ads during a White House meeting of the GOP conference on Tuesday.

By Wednesday, the group had pulled the ads from the air.

SEE ALSO: It's 'rotting like a dead fish': Senate Republicans are trying to revive a healthcare bill 'on life support'

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NOW WATCH: Here's the TV segment that prompted Trump's vicious Twitter attack on Mika Brzezinski

It’s getting little attention right now as the GOP-led Congress struggles to pass a bill to repeal and replace Obamacare, but our employer-sponsored health insurance system is the elephant in the room.

In Washington, the debate largely centers on the level of assistance the federal government should provide to the millions of people under age 65 who don’t get insurance at work. Most Western nations offer universal health coverage.

More than any other country, the US relies on employers to provide insurance, with more than 175 million people gaining coverage through work. For more than 70 years, the nation has struggled to figure out how to provide care to people outside that system.

So how did we end up with such an unusual system that leaves so many people on the outside looking in?

The story starts by the fire. It’s October 1942. In his fireside chat, President Franklin Delano Roosevelt described a growing war.

“With every passing week, the war increases in scope and intensity,” he said. “That is true in Europe, in Africa, in Asia and on all the seas.”

At home there was also a battle — for workers.

“You’re coming out of the Depression and all of a sudden hiring ramps up,” said Sherry Glied, professor of public service at New York University. So many men are abroad that businesses are desperate for employees that “wages start to climb and prices start to climb. We start to see major inflation happening in the U.S. economy,” Glied said.

In that October chat, President Roosevelt argued that economic sacrifices at home were needed as much as any new tank.

“We shall be compelled to stop workers from moving from one war job to another as a matter of personal preference; to stop employers from stealing labor from each other,” Roosevelt said.

That year, the National War Labor Board forbade employers from raising their workers’ salaries — a wage cap. If our employer-sponsored insurance system has an origin story, it is this.

Beyond the wage cap, the labor board also ruled health insurance was exempt from the cap, so employers began to dangle health insurance as a benefit to attract the best and brightest.  

The cherry on top: The IRS decided employer contributions to health insurance premiums were tax free, which meant workers paid less out of their pocket.  

This all happened as a medical miracle unfolded — the arrival of penicillin.

“Before the 1930s, you probably didn’t want to be treated if you were a rational human being,” said NYU’s Glied. “This is the moment where medical care really takes off.”

By 1952, just a decade after Roosevelt’s fireside chat, the economy hummed along.

People wanted new Fords, the best medical care and shiny everything. Private employer-sponsored health insurance exploded.

“How many people have this important private health insurance? Only 8 million people in 1939. But in 1952, 92 million,” Oveta Culp Hobby said in a speech in the mid-1950s. Culp Hobby was President Dwight Eisenhower’s health secretary and just the second women to hold a presidential cabinet post.

She pitched Eisenhower’s plan to provide national insurance to the 63 million uninsured Americans who lacked coverage either because they were too old, worked for employers who didn’t provide insurance or were out of work.

It was the third pass at getting some kind of national health plan in place since the end of the war and join most other Western nations in providing coverage for all.

Melissa Thomasson, a Miami University professor of economics, said each time there's a push to expand coverage, doctors — through their lobbying group, the American Medical Association — launch scorched-earth campaigns.

“Doctors have always worried that it would limit their ability to charge patients what they wanted,” she said. Physicians “say if health insurance is nationalized, it’s likely that government won’t stop there. They’ll start nationalizing other industries, too. So they use the fear factor to kill it,” Thomasson said.

That largely ended any serious attempt at national insurance. The employer-sponsored insurance became king.

Over the decades since, presidents have taken cracks at getting coverage to people outside the employer system — most notably Lyndon Johnson with Medicare and Medicaid, and Barack Obama with Obamacare.

And today it’s President Donald Trump’s turn to try to answer a question that still lacks a sustainable answer — how to care for all those people who fall outside of the employer-sponsored health insurance system.

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The Senate’s health care proposal made it clear that Republicans, despite their rhetoric, are not interested in market-based reform. Instead, they prefer pro-business, pro-privileged reform.

With Senate Republicans planning to rewrite their bill, it’s hard to predict the details of the final proposal. Nonetheless, gauging the House and Senate bills, one can guess that the broad outlines of the final package will be similar.

Because Senate Republicans proposed reducing Medicaid coverage and health care exchange subsidies for low-income individuals, reaction to their bill from consumers, patient advocates and pundits has been overwhelmingly negative. But missing from the national discussion is how the GOP’s legislation also fails to do what party leaders promised their voters.

Republicans have repeatedly assured their base that repealing the Affordable Care Act (ACA) will solve health care cost problems by returning the system to a land of competitive markets. But out-of-control medical costs have been an issue at least since the 1950s. Moreover, the health care system was not based on market forces even before the ACA’s passage.

Breaks for the rich, rollbacks for the poor

To pay for expanded coverage, the ACA raised taxes on drug and insurance companies while imposing an excise tax on the sale of medical devices. It also levied a special investment tax and an income surcharge on individuals earning over US$200,000 a year.

The Senate’s proposal seeks to rescind these taxes, granting financial relief to both corporations and the rich.

The result is that the aged and those at the lower end of the earning scale stand to lose benefits. For example, the GOP bill would roll back Medicaid coverage and decrease the income threshold necessary to qualify for subsidies on the ACA’s state exchanges – from 400 percent of the federal poverty line to 350 percent.

Both the House and Senate proposals would change the formula for how subsidies are calculated, with an overall effect of reducing them.

The Senate bill would also eliminate the individual mandate to purchase insurance and continue requiring that insurers accept applicants with preexisting conditions.

To prevent the state exchanges from being left with only the sickest policyholders and even more rapidly rising premium prices, a proposal introduced on June 26 institutes a waiting period. Anyone who allowed their insurance to lapse for more than 63 days would have to wait six months for their new policy’s coverage to kick in.

The Republicans’ political problem

The House and Senate bills obliterate the idea – for which their party purportedly stands – of competitive markets lowering prices and enhancing consumer welfare. That’s both a political and a policy problem for Republicans.

In the U.S. health care system, neither public officials nor market forces order pricing and delivery. Instead, a messy mixture of government and private-sector power has evolved over decades. This framework has driven up costs so high that the average family now pays over $18,000 a year for insurance.

A key component of this unwieldy public-private system is the insurance industry’s dominance over health care.

Many people assume that insurance companies play a natural function in the financing and organization of health services. Yet insurers did not gain their central position through competitive market processes that sought efficiency. As I wrote in a previous article for The Conversation, in the early part of the 20th century, the American Medical Association (AMA) swept away a bevy of elegant and cost-effective health care arrangements, which they branded “commercial” and “unethical.”

To replace these health care programs, AMA leaders designed the insurance company model at the end of the 1930s. The insurance company model pushed up costs because it incentivized doctors to run up a bill that they then sent off to a faraway, faceless corporation.

One reason the insurance company model took hold is that federal tax policy rewarded companies for providing employees with fringe benefits, including medical insurance. This tax subsidy spread insurance coverage to more people, helped along by the fact that escalating prices were largely hidden from consumers who usually split premium costs with their employer.

As the insurance company model expanded, rapidly mounting medical costs compelled insurers to extend their influence over health care. Over the course of many decades, insurers evolved beyond simply financing health services to also supervising physicians and regulating medical care – all in the name of cost containment. The insurance company model grew. And both the 1965 Medicare program and the 2010 ACA incorporated its logic.

Despite this history, the Republicans’ legislation neglects structural changes, somehow imagining that 2009, the year before the ACA passed, represented halcyon days for the U.S. health care system.

True, it’s helpful that Republicans propose reducing ACA requirements so that consumers are permitted to purchase good, but not necessarily gold-plated, coverage. Consumers would instead be able to choose lower-priced policies with smaller deductibles in lieu of high-cost policies with more generous benefits – for example, mental health and drug rehabilitation coverages – that are nonetheless difficult to tap into because of high annual deductibles. But this policy change is weak medicine to remedy our ailing system. Do Republicans really believe that changing mandatory benefits guidelines will be the one tweak that finally gets our country’s health care costs under control?

At bottom, Republican proposals have left vulnerable populations either without coverage or with reduced benefits, but still trapped inside a high-cost system.

This is a key weakness before the Republican base and before conservative ideologues. For many low-income individuals, no amount of bootstrapping or hard work ethic will get them adequate health insurance because coverage is simply too expensive. And that flies in the face of the Republican political narrative.

Does this make economic sense?

Republicans may be too timid or lack the votes to advance structural reform. And they may feel it necessary to prop up insurance companies struggling with the costs of insuring high-risk patients. That’s a fair calculation.

But are they ready to create a health care system that aids every group except the working poor? The wealthy will have their health care and their tax cuts. The middle classes will continue to enjoy expensive, generous insurance that’s indirectly funded through the tax code. And insurance companies will accept whatever assistance the government provides – from tax cuts to coverage penalty periods – to continue increasing their authority over the medical system.

That’s an arrangement that leaves out the very groups that are most desperate for health care reform: lower-income families and the working poor.

SEE ALSO: Republicans consider a novel idea: What if Obamacare repeal weren't a tax cut for the rich?

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Republicans have made lower insurance premiums one of their biggest promises on healthcare.

But an analysis by the Kaiser Family Foundation found that once you factor in tax credits, the endpoint premium payment for most Americans in the individual health insurance market would increase under the Better Care Reconciliation Act, Senate Republicans' bill to overhaul the US healthcare system.

The nonpartisan health-policy think tank broke down just how much premiums for a silver-level plan in the individual insurance market would increase for people of different ages, factoring the effect of proposed tax credits.

While the individual market includes only about 7% of the population, the premiums in the market have become a central part of the debate over the future of healthcare. Republicans often bring up the increase in premiums in this market as a reason that the Affordable Care Act, or Obamacare, needs to be replaced.

Overall, Kaiser found that premiums after tax credits in the market would increase by 74% under the BCRA compared with the ACA.

Additionally, older Americans would see an even steeper increase for a variety of reasons.

For one, older people could be charged more under the BCRA than the ACA. Under current law, older Americans can be charged only three times as much for premiums as younger Americans. Under the Senate bill, this would increase to five times as much.

Additionally, the premium tax credit structure would be changed. The formula for how much of a person's income is supposed to be spent on a premium would gradually increase as they age under the BCRA.

Add it all up, and almost everyone would see an increase in their premiums for a silver plan, becoming more dramatic the older someone gets.

Given the premium increases, there is also a good chance that people would end up getting less-generous health insurance.

According to an analysis by the nonpartisan Congressional Budget Office, this kind of jump would mean that some people on the individual market who currently have a plan in the silver bracket or higher might trade down to a bronze plan, which has less-generous coverage. Currently, under a silver plan, 70% of healthcare costs are covered by the insurer; in a bronze plan under the BCRA, that figure would be 58%.

Insurers paying a lower percentage of costs means people would have to make up the difference, leading to higher deductibles and co-pays. So to get affordable premiums, people would have to get plans with higher out-of-pocket costs.

According to the Kaiser study, the situation could be worse for people with lower incomes, who would see much less generous tax credits for the same silver plan.

While the raw dollar jump for those making above 200% of the federal poverty line would be dramatic, the percentage increase for low-income people would be worse. According to Kaiser, the premium increase for someone between 55 and 64 with an income above 200% of the federal poverty line would be 96%, to $782 a month from $399. For someone in the same age bracket making less than 200% of the poverty line, however, it would be a whopping 294% jump, to $272 from $69.

If the bill were to become law, regardless of how much people make or how old they are, it wouldn't be a question of whether premiums after tax credits would increase, but by how much.

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The Republican healthcare plan, both on the House and Senate side, is not getting much support from the American public.

Polls have shown the House bill to be among the most unpopular of any major piece of legislation in the last two decades. Those numbers have not improved in the past few weeks with the introduction of the Senate's version of the legislation.

A new poll from Morning Consult and Politico found that many Americans don't think the GOP healthcare push will result in better outcomes for the healthcare system — or for themselves.

Overall, 44% said that the US healthcare system would be worse off under the GOP legislation, while 28% said it would improve.

Forty-five percent of people believed the Republican healthcare plan would increase their personal costs, while only 21% thought it would decrease costs. Republicans have touted the ability of the plan to bring costs down, but it doesn't appear to be resonating with voters.

The Congressional Budget Office said in its analysis of both the House and Senate bills that premiums for people in the individual insurance market would be lower than the current baseline by 2020. But the office also said out-of-pocket costs would increase. Additionally, studies from nonpartisan groups have estimated costs would increase in a variety of ways.

In terms of coverage, 52% of people in the survey said they expect fewer people to have health insurance if the GOP plan becomes law, while 18% said they thought the legislation would increase the number of people covered. The CBO projected 22 million fewer people will be insured in 2026 under the Senate bill compared to the current baseline. 

Currently, the legislation is stalled in the Senate as the moderate and conservative wings of the party's Republican conference have been unable to come to a compromise on the bill.

SEE ALSO: Here's how much health insurance premiums could increase under the Senate healthcare bill

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Hillary Clinton fired back at the official Republican Party Twitter account after it asked for her healthcare plan on Wednesday.

The Republican National Committee's Twitter account went after Democrats on Wednesday with a string of clips featuring Democratic political figures acknowledging faults with the Affordable Care Act, the healthcare law better known as Obamacare.

Each tweet claimed Democrats had no healthcare alternative and asked the politicians — such as Sens. Bernie Sanders and Elizabeth Warren, as well as former President Bill Clinton — for their plans to fix the ACA.

One of the tweets featured a clip of Hillary Clinton speaking at a 2016 campaign event about the ACA.

"'We've got to fix what’s broken.' Where's your plan, @HillaryClinton?"the RNC tweeted.

In reply, Clinton linked to a page from her 2016 campaign website with details on plans designed to expand insurance coverage, bring down drug prices, combat rising insurance premiums, and more.

"Right here. Includes radical provisions like how not to kick 23 mil ppl off their coverage. Feel free to run w/ it," Clinton tweeted along with the link.

According to an estimate by the nonpartisan Congressional Budget Office, the House GOP Obamacare replacement — the American Health Care Act — would result in 23 million people losing insurance in 2026 compared with the baseline under Obamacare.

And the Senate version of the bill has been stalled because of a disagreement between the moderate and conservative members of the GOP conference. That bill, the Better Care Reconciliation Act, would leave 22 million more people without insurance by 2026, the CBO estimated.

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With the Senate Republican healthcare bill stalled due to disagreements within the party, some Republicans are admitting they may have to move to a plan B: working with Democrats.

Senate Majority Leader Mitch McConnell on Thursday said during an event in Kentucky that if GOP senators fail to reach an agreement on a bill that can get 50 votes in the chamber, they would have to work with the other party on a way to stabilize the Obamacare insurance markets.

"If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur," McConnell said.

McConnell pointed to increasing premiums in the individual insurance marketplaces as the reason Republicans would have to reach across the aisle.

"No action is not an alternative," McConnell said, according to The Associated Press. "We've got the insurance markets imploding all over the country, including in this state."

McConnell reportedly used the prospect of working with Democrats as a threat earlier in the negotiations over the Senate healthcare bill, the Better Care Reconciliation Act (BCRA).

Sen. Jerry Moran of Kansas on Thursday also suggested Republicans may have to work with their Democratic counterparts to solve healthcare. Moran said he would have preferred to deliberate the bill in a more open fashion in the Senate, instead of using the more secretive process for which McConnell was criticized, and "figure out where there are 60 votes to pass something."

The Kansas Republican also said there was no consensus within the 52-member GOP conference on the healthcare bill.

The BCRA hit a roadblock after its introduction. Conservative members rejected the bill because it did not go far enough in its repeal of Obamacare. On the other hand, more moderate members said the bill goes too far in stripping away funding from programs like Medicaid.

Senate Minority Leader Chuck Schumer welcomed the remarks from McConnell is a statement. The Senate's top Democrat expressed willingness to work with Republicans if they chose to do so.

"It’s encouraging that Sen. McConnell today acknowledged that the issues with the exchanges are fixable, and opened the door to bipartisan solutions to improve our health care system," Schumer said. "As we’ve said time and time again, Democrats are eager to work with Republicans to stabilize the markets and improve the law."

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With the Senate Republican healthcare bill at an impasse, Republican leaders are weighing a proposal from Sen. Ted Cruz to try to move it over the finish line.

Cruz's plan, which is also supported by Sen. Mike Lee of Utah, proposes to change the type of insurance plans that could be offered under the Better Care Reconciliation Act (BCRA).

The plan has drawn widespread praise in conservative circles over the past several days. But even if it brings Cruz and fellow conservative-leaning senators on board, it may turn away more moderate members of the caucus.

Given that political reality, Senate Majority Leader Mitch McConnell on Thursday suggested that Republicans might have to work with Democrats to solve healthcare.

Cruz's solution does, however, have backing from President Donald Trump's White House.

"We support Sen. Cruz and Sen. Lee's efforts," said Marc Short, the White House director of legislative affairs, on "Fox News Sunday."

'A recipe for instability'

The Cruz plan would allow insurers to offer plans in the individual insurance market that do not adhere to two major regulations imposed under the Affordable Care Act, or Obamacare, as long as they offer one that does.

So-called essential health benefits (EHBs) require insurers to cover 10 basic benefits, including maternity care, mental healthcare, and emergency-room trips. Community rating, the other mandate under Obamacare, requires that people of the same age in a given area be charged the same amount for premiums. That helps people with preexisting conditions to not be charged more for care.

Cruz has argued that the virtual repeal of those mandates would allow insurers to offer cheaper plans to people that want them and bring down costs for everyone.

But experts say it could mean that plans that feature EHBs and community rating could be priced higher than those without — to the point that they become too expensive for the people that need them. The two tiers of plans, experts say, could allow insurers to box sick people into the more generous plans at a higher cost.

"Choice always sounds so good, like with the Cruz amendment,"said Larry Levitt, a senior vice president at the Kaiser Family Foundation, a nonpartisan health policy think tank. "But in insurance, it's generally a recipe for instability and discrimination."

A growing number of fans

The proposed Cruz amendment has begun to gather praise from lawmakers and outside groups on the right flank of the Republican Party.

For one thing, conservative holdouts in the Senate appear to be supportive of the plan. Lee has advocated for the amendment and has made its addition a virtual deal-breaker for his vote.

"We can’t speak for other members," a Lee aide told Business Insider. "But we will not vote for the Senate bill without this change."

Other non-committal senators, such as Rand Paul of Kentucky, have not commented on the proposal. 

The traction around the amendment was enough, however, to prompt Republican leadership to send the bill to the Congressional Budget Office to be scored, alongside another tweaked version of the bill without the amendment.

It may also clear a way for the Senate's bill to pass the House. Upon the BRCA's release, reports suggested that House GOP leadership would be open to passing the Senate's version of a bill as it stood. But conservatives in the chamber, such as the House Freedom Caucus, brushed back at that plan.

The Cruz amendment could change that since it resembles amendments that won over House conservatives during the production of the American Health Care Act, the House's legislation, in May. According to a source close to the Freedom Caucus, the Senate bill with a Cruz-like amendment could garner the support of the key conservative group.

"The group generally supports it but hasn't taken any formal position so it'd be too soon to say if the full group supports it," the source told Business Insider. "For example, if pro-life protections fall off, a lot of HFC will oppose regardless of Cruz."

Rep. Mark Meadows, the chair of the Freedom Caucus, has expressed support for the addition.

 Outside of Capitol Hill, conservative groups have also praised Cruz's suggestion.

Influential conservative groups like the Heritage Foundation's political arm and FreedomWorks expressed support for the idea.

"We continue to believe that the best outcome is language modeled after the 2015 reconciliation bill that repealed much of Obamacare," FreedomWorks President Adam Brandon said in a statement Wednesday. "But if Senate Republicans insist on tweaking Obamacare, we urge them to adopt language being pushed by Sens. Cruz and Lee that will provide consumers with more choice and truly affordable health insurance coverage."

Heritage Action CEO Michael Needham had similar praise in a statement.

"It is encouraging to see Senate leadership exploring the merits of serious proposals that would inject much-needed consumer choice and competition into an otherwise deteriorating market," Needham said.

Victory? That's no guarantee

Cruz's plan changes the political calculus for the bill. But so far, it's unclear if it could get Republicans the 50-vote threshold they need to pass the legislation.

The key holdup would likely be moderates in the Republican conference. Those that already oppose the bill, like Sen. Susan Collins and Dean Heller, would be unlikely to come on board since they are concerned about some of what the BCRA already proposes to do to change certain features of Obamacare.

The amendment may also lose uncommitted GOP senators, like Louisiana's Bill Cassidy.

Cassidy has said that any plan must adhere to the "Kimmel Test." The barometer, named after late night host Jimmy Kimmel, stipulates that any Republican bill must preserve all protections for people with preexisting conditions. Given the Cruz amendment's proposed changes, it would likely not qualify.

While moderate GOP senators are the most important point of opposition for Republican leaders, the proposed changes to the insurance market that would occur under the Cruz plan drew the ire of Democrats. Senate Minority Leader Chuck Schumer blasted the amendment in a statement on Thursday, saying it would raise out-of-pocket costs and harm people with preexisting conditions.

"Make no mistake, the Cruz amendment is a hoax," Schumer's statement said. "Under the guise of lowering premiums, it makes healthcare more expensive because deductibles and copayments would be so onerous that many Americans would pay much more out of their pockets than they pay today. It’s a foolhardy trade to exchange lower premiums for far more expensive deductibles and copayments."

The Senate reconvenes next week after its July 4 recess, but a vote on the healthcare bill is not expected right away.

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With negotiations having appeared to hit an impasse, President Donald Trump used Twitter on Monday morning to try to put pressure on Republican lawmakers to pass a healthcare bill.

"I cannot imagine that Congress would dare to leave Washington without a beautiful new HealthCare bill fully approved and ready to go!" Trump tweeted.

Senate Majority Leader Mitch McConnell is facing opposition from both sides of his conference over his draft of the Better Care Reconciliation Act.

Conservative members, like Ted Cruz and Mike Lee, believe the bill does not go far enough in its repeal of the Affordable Care Act and are pushing for more regulatory rollbacks. Moderate members, like Susan Collins and Dean Heller, believe the bill goes too far with cuts to Medicaid and with other regulatory changes.

Even members whom leadership traditionally relies on like Jerry Moran and John Hoeven also expressed doubts about the current form of the BCRA over the past week.

Over this disagreement looms the monthlong August recess, which McConnell has declared is the unofficial deadline for getting the BCRA passed. After that, McConnell warned, Republicans would have to work with Democrats on a short-term stabilization bill for the individual insurance market.

Because of the stalled out negotiations, 10 GOP senators sent a letter asking McConnell to delay the start of the August recess so Republicans could work on their agenda, including the BCRA.

The Trump administration also favors delaying the recess until a bill is done, as evidenced by Trump's tweet and by the White House chief of staff, Reince Priebus, who told "Fox News Sunday" that a bill needed to get done.

"Whether it'd be before August recess or during August recess, the president expects the Senate to fulfill the promises it made to the American people," Priebus said.

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The percentage of Americans without health insurance rose in the second quarter of 2017, according to a Gallup-Sharecare survey.

The uninsured rate increased to 11.7%, the second quarterly increase in a row after the rate hit a record low of 10.9% in the third and fourth quarters of 2016. The uninsured rate was 11.3% during the first quarter.

Gallup-Sharecare said the rate still well below the peak of 18.0% in 2013 — just before the launch of the Affordable Care Act's individual insurance exchanges. But it represents a significant uptick since the end of last year.

"Although the increase in the uninsured rate from the end of 2016 to Gallup's most recent update is small on a percentage basis (0.8 points), it is statistically significant given the very large sample sizes involved, and translates into nearly 2 million Americans who, apparently, have already dropped out of the insured ranks,"a post from Gallup-Sharecare said.

The result comes from a survey of more than 45,000 people over the second quarter.

Gallup-Sharecare cited a few possible reasons the uninsured rate could be increasing, such as higher premiums and insurer exits from the Obamacare markets. The post also cited uncertainty in Washington as a possible factor.

"Uncertainty surrounding the healthcare law also may be driving the increase. President Donald Trump's executive order permitting agencies to waive or delay provisions that 'impose a fiscal burden' on individuals, as well as the prospect of a new healthcare law may be causing consumers to question whether the penalty for not having insurance will be enforced," Gallup-Sharecare said.

Republicans in the Senate are currently debating a law that would repeal major parts of Obamacare.

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Senate Majority Leader Mitch McConnell is planning to roll out an updated version of the Senate GOP healthcare bill Thursday, according to a new report.

The move comes as leadership hopes the Senate can bring the bill, the Better Care Reconciliation (BCRA), to the floor for a vote by the end of next week, according to Politico's Burgess Everett, Jennifer Haberkorn, and Josh Dawsey.

A new score from the Congressional Budget Office would be released as soon as Monday under this timeline, the report said.

The legislation faces an uncertain future as conservative and moderate members of the GOP conference took issue with the first iteration of the legislation.

The opposition forced McConnell to delay a planned vote on the bill before the week-long July 4 recess, during which he raised doubts that the bill would ever be passed.

Politico reported that an amendment from Sen. Ted Cruz, which would allow insurers to sell plans that did not comply with two major Obamacare regulations, had not been sent in its entirety to the CBO, complicating its potential addition to the legislation.

Without a full evaluation by the CBO, it is unlikely many GOP lawmakers would get behind the idea.

It's unclear whether the addition would be enough to get the bill passed, as many Republican members have expressed misgivings about how Cruz's amendment would impact protections for people with preexisting conditions.

Many members in recent days have openly speculated that the BCRA may never get the support it needs to pass.

Sen. John McCain called the bill "dead" on Sunday, and some Republicans have already talked about working with Democrats on passing a short-term bill to stabilize the individual insurance market.

Other conservative members are pushing instead for a bill that would repeal Obamacare and working on a repeal bill at another time.

This approach is backed by the Trump administration. Vice President Mike Pence told conservative talk radio host Rush Limbaugh on Monday, "If they can't pass this carefully crafted repeal and replace bill, we ought to repeal only."

Read the full report at Politico »

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