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The latest news on Obamacare from Business Insider

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    obama trump

    • Obamacare premiums increased between 2017 and 2018, according to a new study.
    • The average cost of the cheapest silver-tier plan increased 32% across the US. Gold-tier plans saw a 19.1% increase.
    • There were a variety of reasons for the increases, from Trump administration changes to marketplace fundamentals.
    • Check out the increases for silver and gold plans by state in maps below.

    Affordable Care Act premiums are headed in the same direction as last year: higher.

    According to a new study from the Urban Institute and the Robert Wood Johnson Foundation, premiums in the Obamacare exchanges — which provide insurance for people who do not get coverage through work or a government program like Medicaid — jumped 32% nationally for the lowest-cost silver-tier plan, as well as 19.1% for gold-tier plans.

    There are a variety of reasons for the increase in premiums from last year, according to the study, ranging from Trump administration actions to unresolved deficiencies in the individual insurance market.

    "The premium increases reflect significant policy changes and policy debates specifically affecting insurer decisions for the 2018 plan year as well as more typical annual considerations such as trend and healthcare costs," the researchers wrote.

    Of particular interest to the researchers was the difference between the increase for silver-level plans, the middle-tier of Obamacare coverage, and the gold-level plans.

    Silver plans generally saw larger increases in premiums because insurers predominately loaded onto those plans the loss of cost-sharing reduction (CSR) payments, which helped offset the cost of covering lower-income patients. President Donald Trump ended the CSR payments in October.

    States had the option of loading the lost CSR payments into just the silver tier or spreading them out among all the levels.

    "26 states had insurers allocate the CSR costs to silver marketplace premiums alone, eight states had the costs allocated to silver plans on and off the marketplaces, three states had insurers spread the costs across all metal tiers in the marketplace, three had insurers spread the costs across all metal tiers on and off the marketplace, and in three states' approaches varied across insurers," the study found.

    Much of the cost increases won't be passed onto consumers, since 70% receive subsidies, which bring their premiums below $75 a month. But it means the program costs the federal government more in the end than if Trump had kept the payments in effect.

    Overall, 15 states saw an increase of more than 40% for the lowest cost silver plan while eight saw an increase of 10% or less. Of those, four saw a decrease in premiums.

    Obamacare premium increases  Silver plans

    The largest increase in the lowest-cost gold plan premiums came in Kentucky, a 66.2% pop. Kentucky also shifted from a state-based marketplace to the federally run Healthcare.gov platform for the first time in 2017 and suffered a drop off in enrollment last year.

    On the other end of the spectrum was Alaska, which saw gold premiums fall by an average of 27.9% between 2017 and 2018.

    Obamacare premium increases  Gold plans

    SEE ALSO: America's biggest companies are saying exactly what Republicans want to hear about the massive GOP tax law

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    RICHFIELD, OHIO - MARCH 29: U.S. President Donald Trump speaks to a crowd gathered at the Local 18 Richfield Facility of the Operating Engineers Apprentice and Training, a union and apprentice training center specializing in the repair and operation of heavy equipment on March 29, 2018 in Richfield, Ohio. President Trump's remarks centered upon infrastructure investment in the economy and labor statistics. (Photo by Jeff Swensen/Getty Images)

    • President Donald Trump renewed his calls for the Senate to kill the legislative filibuster, citing it as a key obstacle to why there is no permanent solution for the Deferred Action for Childhood Arrivals program and funding for a wall along the US-Mexico border.
    • A history of major policy failures during Trump's administration stem from factors outside of clearing a 60-vote minimum.

    President Donald Trump once again took aim at the Senate filibuster, a procedural maneuver that can thwart legislation without at least 60 votes to end debate on the subject.

    Trump regularly bashes the filibuster as an obstacle to his agenda. But it rarely factors into why certain things are not able to pass. In many cases, it is because the Republican conference is not unified enough on their own. 

    Trump declared on Monday morning that the Deferred Action for Childhood Arrivals program (DACA) is "dead" amid frustrations with his inability find a permanent solution to the issue many want to see resolved.

    "DACA is dead because the Democrats didn’t care or act, and now everyone wants to get onto the DACA bandwagon... No longer works," Trump wrote on Twitter. "Must build Wall and secure our borders with proper Border legislation. Democrats want No Borders, hence drugs and crime!"

    Trump also railed against the filibuster. The president would prefer a simple majority to end debate, like is done with executive nominations.

    DACA collapsed in the Senate because of other factors

    All the proposals for DACA and border security funding went down in flames in February for various reasons unrelated to the filibuster.

    The most popular compromise in the Senate would have given in to the White House's demands, which included $25 billion for construction of the wall along the US-Mexico border and other security measures in addition to providing a pathway to citizenship for DACA recipients. That plan received some Democratic support, but failed 54-45.

    Even though that plan failed to surpass the 60-vote threshold, the filibuster was irrelevant in that case as the Trump administration had already rejected the deal.

    White House officials called it dead on arrival before a vote was even held, and the Department of Homeland Security called it "an egregious violation of the four compromise pillars laid out by the President's immigration reform framework."

    The one plan the White House actually backed could not even muster enough support from the entire Republican conference.

    An amendment from Iowa Sen. Chuck Grassley, which included many of the same elements of the other plan but significantly reduced legal immigration levels, only managed to get 39 'yes' votes. 

    Repealing and replacing Obamacare failed too

    In the first year of Trump's presidency, Republicans repeatedly stepped on the proverbial rake in their attempts to repeal and replace President Barack Obama's signature law, the Affordable Care Act.

    Almost every month of 2017 was full of setbacks in trying to repeal Obamacare. In July, Senate Majority Leader Mitch McConnell said, "It's time to move on" after their plan could not even get 50 Republican votes.

    Months later in September, a revamped plan from Sens. Lindsey Graham and Bill Cassidy once again failed to get at least 50 Republicans willing to support it, leading McConnell to scrap it altogether.

    Republicans "nuked" the filibuster for Supreme Court nominees when it became apparent not enough Democrats would support Neil Gorsuch's confirmation. The tax overhaul bill was done through a process called "reconciliation," which is why it did not require 60 votes, but also why it did not go as far as many Republicans had hoped.

    The bottom line is that when Trump blames the filibuster as his primary obstacle to achieving more legislative wins, he is often ignoring underlying factors, mainly that in most cases Republicans cannot agree enough to make good on years of promises.

    SEE ALSO: Nancy Pelosi could unexpectedly deliver Republicans their worst nightmare — and it could lead to an electoral bloodbath

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    Donald Trump and barack Obama

    • The Trump administration is moving forward with a new plan to expand the use of short-term health insurance policies.
    • Democrats said the new plan would undermine patient protections and drive up prices for sick Americans.
    • Many health industry groups such as the AARP, American Heart Association, and America's Health Insurance Plans have come out against the plan.

    Democrats and healthcare groups are attacking the Trump administration's latest healthcare plan as an attempt to undermine the core protections of Obamacare and increase costs for sicker Americans.

    The Trump administration's new plan would expand the use of short-term, limited-duration health insurance plans for people who have a lapse in coverage. Currently, if a person experienced a lapse in coverage, for example after the loss of their job, the individual can get a short-duration insurance plan. These plans last a maximum of three months until the individual can sign up for a longer-term plan through the Affordable Care Act exchanges.

    Under the proposed rule, these plans could last as long as 12 months, and the Department of Health and Human Services (HHS) is considering letting people renew these plans at the end of the time limit. This would, in essence, allow someone to remain on the short-term plans in perpetuity.

    HHS and the Trump administration argue that these expanded plans would give healthy Americans a lower-cost option for coverage, as compared to the more permanent plans found in the Affordable Care Act (ACA), or Obamacare, exchanges. But according to health policy experts, these plans could also cause trouble.

    The problems with short-term plans

    According to the Kaiser Family Foundation, a nonpartisan health policy think tank, these new plans could cause substantial changes to the individual insurance market — where people who do not receive coverage from an employer or government program access coverage.

    In particular, said Kaiser, these plans have three major problems that could cause issues for both the people who sign up for short-term coverage and those who remain in Obamacare's marketplace:

    1. The short-term plans are not as generous, which could cause problems for people on the plans who get sick. These plans do not have to adhere to all regulations laid out by the ACA, such as covering the 10 essential health benefits and lifetime limits on benefits. This means that a person who becomes ill while on one of the plans could face high out-of-pocket costs.
    2. Short-term plans can deny coverage based on pre-existing conditions or charge people more if they have a pre-existing condition. Even after a person gets sick after signing up for a short-term plan, said the Kaiser report, an insurer can investigate to determine if the illness counts as a pre-existing condition and retroactively deny coverage.
    3. More people leaving for short-term plans could increase costs for people who remain in the ACA marketplace. Young and healthy people help to lower the cost of premiums in the ACA marketplace. So as more of these young, healthy people shift to cheaper short-term plans, those who remain in the marketplace will be sicker, older, and more expensive to cover. In turn, premiums in the marketplace would increase.

    While many people would get higher government subsides to offset the increased costs, many middle-class Americans who do not qualify for those premium subsidies would see large cost increases.

    Democrats, industry groups express concerns

    Given these limitations, Democrats expressed concern about the effects of the expanded plans in a letter to HHS Secretary Alex Azar, Labor Secretary Alexander Acosta, and Treasury Secretary Steven Mnuchin.

    "Unfortunately, creating a new class of health insurance plans that lack basic patient protections and could lead to higher prices for seniors, those with pre-existing conditions, and any American who wants to purchase a plan ," the letter said.

    In addition to worries from Democrats, many health industry groups came out against the idea, including AARP, the American Heart Association, the American Academy of Family Physicians, and others. America's Health Insurance Plans, the largest insurance lobby in the US, also came out against the expansion of the short-term plans.

    "We are concerned that this proposed rule will lead to more people being uninsured and under-insured, and to higher costs in the long run," AHIP CEO Matt Eyles said in a statement on Monday. "Short-term plans can provide an important temporary bridge for Americans who are transitioning between plans. But they are not a replacement for comprehensive coverage."

    The public comment period on the rule ends Monday and a final rule is expected to be released in the coming months.

    SEE ALSO: Trump's trade fight is getting blasted by some of the most powerful economic groups in the world

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    tom price trump

    • Tom Price, President Donald Trump's former Health and Human Services Secretary, said the GOP's repeal of the Affordable Care Act's individual mandate was a bad thing for insurance markets.
    • Price's statement broke from the traditional Republican position and contradicts previous statements Price made during the Obamacare repeal push in 2017.

    Tom Price, the former Health and Human Services Secretary under President Donald Trump, criticized a key Republican change to Obamacare during a speech Tuesday.

    Speaking at the World Health Care Congress, Price suggested the Republican Party's repeal of Obamacare's individual mandate — the requirement to buy insurance or face a penalty — was a faulty idea. He said it would drive up costs for people in the individual insurance marketplace.

    "There are many, and I’m one of them, who believes that that actually will harm the pool in the exchange market, because you’ll likely have individuals who are younger and healthier not participating in that market, and consequently, that drives up the cost for other folks within that market," Price said, according to the Washington Times.

    Price's argument echoes that of many health policy experts. Without a mandate to compel younger, healthier people to sign up for coverage, many are projected drop out of the Obamacare marketplaces. That would leave a pool of older, sicker people in those marketplaces that cost more for insurers to cover. To offset the higher costs, insurers would be forced to increase premiums.

    Though most people in the marketplaces would not see their premiums go up due to federal subsidies, those families who don't qualify for subsidies could see costs soar. In turn, many people could drop coverage due to the increased expenses, a report from the Congressional Budget Office has shown.

    The mandate was repealed as part of the Republican tax law that passed in December.

    While Price's analysis on Tuesday is in line with many healthcare experts, it contradicts not only the Republican party's position on mandate repeal, but also Price's own statements from 2017.

    "The individual mandate is actually one of those things that is driving up the cost for the American people in terms of coverage," Price said in July 2017, in the midst of the GOP's effort to repeal Obamacare.

    Price resigned as HHS secretary in September after extensive reporting on his use of private air travel. According to records, Price cost taxpayers more than $1 million between his use of private planes for domestic travel and military jets for recent trips to Africa, Europe, and Asia.

    Price's comments were the second in as many days from Republicans sounding a critical tone on the tax law. Sen. Marc Rubio, a Florida Republican, said in an interview published Monday that there was "no evidence" any of the law's provisions have benefited average workers.

    SEE ALSO: MARCO RUBIO: There's 'no evidence whatsoever' that Trump's tax bill has helped American workers

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    Doanld Trump Barack Obama

    • Virginia and Maryland posted proposed rates for 2019 Obamacare plans, the first states to do so.
    • The proposals showed significant proposed increases in premiums for many of the plans.
    • Insurance industry professionals and health policy experts say the market is partly to blame, but President Donald Trump also made the problem worse.

    Affordable Care Act premiums look like they will continue to soar in 2019, according to early indications from a handful of states. And President Donald Trump may bear some of the blame.

    Virginia and Maryland were the first states to post initial proposals for plans through the Obamacare marketplace, which can be purchased by people who do not receive insurance through work or a government program like Medicaid.

    In those rate requests, most insurers asked for double-digit increases from 2018 to 2019 following the upward trend in health insurance costs for the marketplaces:

    • CareFirst, a member of the Blue Cross Blue Shield Association that focuses on Maryland, requested a 91% increase for its PPO plan in the state and a 19% increase for its HMO plan, according to the Maryland Insurance Administration.
    • The other provider in Maryland, the Kaiser Foundation, requested a 37% jump.

    The average increase requested in Maryland was 30%, according to the insurance administration.

    In Virginia:

    • CareFirst requested 64% and 27% increases for its PPO and HMO plans, respectively.
    • Kaiser asked for a 32% bump.
    • Virginia-based Piedmont requested a 18% increase.
    • Cigna asked for a 15% increase.
    • And Anthem asked for a 6% jump.
    • The only request for a decrease came from Optima, which wants to lower premiums by 2% in the state, though the company's rates are among the priciest in the country

    Charles Gaba, who writes for the health policy blog ACASignups, said that based on the number of people signed up for each plan, the average rate hike works out to 13.4% in Virginia.

    The reasons for the increases, according to insurance commissioners and experts, is twofold.

    On one hand are the long-term problems of the marketplaces. Fewer than expected young people have signed up for Obamacare plans, making the pool of people in the marketplace older and more expensive to cover for insurers.

    But CareFirst CEO Chet Burrell told The Washington Post that the Trump administration's actions have made the Obamacare marketplaces "materially worse." He said the company could consider leaving the space altogether. 

    "Continuing actions on the part of the administration to systematically undermine the market and make it almost impossible to carry out the mission," Burrell said. "If continued efforts at the federal level undermine the marketplaces, I would think the board would have to examine what they would want — that’s very much on their mind."

    The Trump administration eliminated the individual mandate — the requirement to buy coverage or face a financial penalty — as part of the GOP tax law.

    The Congressional Budget Office has projected that eliminating the mandate will hike premiums by 10% and leave 13 million more people without insurance by 2027.

    Larry Levitt, senior vice president at the Kaiser Family Foundation, a nonpartisan health policy think tank, said Trump's repeal of the mandate would force premium hikes much higher in 2019.

    "With insurers now mostly profitable in the ACA individual insurance market, I would have expected single-digit premium increases for 2019 reflecting health cost growth," Levitt tweeted Monday. "With repeal of the individual mandate and expansion of short-term plans, double-digit hikes are now likely."

    SEE ALSO: The pay increases that were supposed to come from the Trump tax law haven't shown up yet

    Join the conversation about this story »

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    BI Graphics_The Secret History of Calories 2x1

    • Starting this week, chain restaurants are required to post calorie counts on their menus as part of the 2010 Affordable Care Act.
    • The measure is designed to help people eat healthier, but it's important to remember where calories come from in the first place — and to know that they're not the end-all, be-all when it comes to nutrition.
    • In 1918, a Los Angeles physician played a major role in popularizing the calorie as a way of losing weight.
    • It was the first mention of the word in popular culture — and the world's first viral diet book.

    Standing before a room of women in Los Angeles, Lulu Hunt Peters wrote a word on a blackboard that she said held the keys to empowerment. It was a word most of her audience had never heard before. Peters insisted it was just as important as terms like "foot" and "yard," and that if they came to understand and use it, they would be serving their country and themselves.

    The word was "calorie."

    It was 1917, and although the calorie had been used in chemistry for decades, Peters was responsible for popularizing the idea that all we need to become healthier is knowing how much energy is in our food and cutting back the excess. More than 100 years later, that logic lives on in new US rules that require chain restaurants and stores that sell prepared food to list calorie counts on menus. 

    Peters' teachings weren’t all academic. She also referred to overweight people as "fireless cookers" and accused them of hoarding the valuable wartime commodity of fat "in their own anatomy." Nevertheless, Peters' weight-loss strategy has become so popular that some experts worry it now eclipses more important aspects of nutrition.

    Yet while Peters' concept of calories has managed to stick around for 100 years, few have heard her name. As one of a handful of female physicians in California at the turn of the 20th century, Peters occupied a tenuous role as a health authority. After initially opening up her own private practice, she struggled to feel satisfied with her career.

    It was only after America entered the first World War that Peters had the opportunity to find her voice — first as a leader of a local women's club and finally as America's most enduring diet guru.

    'Hereafter, you are going to eat calories of food'

    Lulu Peters was the picture of 1920s fashion.

    She wore her dark hair in the flapper style, bobbed and adorned with glittering headbands, and sported luxurious furs. Her ears were decorated with gleaming pearls. She wasn't rail thin, as the social mores of middle-class white America said she ought to be, but she was 70 pounds leaner than she had been when she'd graduated from medical school — a point she emphasized with pride in a pamphlet she sold for 25 cents and later turned into the world's first best-selling diet book.

    lulu hunt peters 1923 press photo

    When it came to the science of nutrition and weight loss, Peters was in many ways decades ahead of her time. While ads in local newspapers pushed women to try everything from smoking ("Reach for a Lucky instead of a sweet!") to wearing medicated rubber garments to lose weight, Peters was breaking down complex scientific concepts like metabolism into accessible ideas that could be used to slim down.

    In 1910, when the average life expectancy was 49 years, most Americans had never heard of things like calories, proteins, or carbohydrates. Even the science of vitamins was a fledgling endeavor characterized by a great deal of pseudoscience. Through her newspaper columns and clubhouse talks, Peters introduced hundreds of people to these ideas, and even began to link unhealthy eating with specific diseases. She went so far as to recommend intermittent fasting for those struggling to lose weight, a topic that is only now beginning to emerge in the scientific literature.

    reach for a lucky instead of a sweet

    Still, what Peters taught her followers about calories has endured the longest: that all you need to do to lose weight is consume fewer calories than you burn.

    "Instead of saying one slice of bread, or a piece of pie, you will say 100 Calories of bread, 350 Calories of pie," she wrote in 1918. "Hereafter, you are going to eat calories of food."

    'How dare you hoard fat when our nation needs it?'

    In 1909, Peters was one of about 1,000 women across the country to graduate as a doctor of medicine.

    War and its demand for medical workers had helped temporarily ease some of the barriers blocking women from entering universities, and in 1910 the percentage of women physicians was at an all-time high at 5%. Shortly after receiving her degree from the University of California, Peters got a job leading the Los Angeles County Hospital's pathology lab. Several years later, even as the percentage of women medical-school graduates receded to below 3%, she secured a role as the chair of the public-health committee for the California women's club federation of Los Angeles, a position that a local newspaper described as having "more power than the entire city health office."

    Still, Peters occupied a tenuous position in a society led by men. Even as a leading physician with two medical degrees, most of her roles were unpaid, including a one-year stint with the American Red Cross in 1918 during World War I. Many of the public-health events she attended were derided in local newspapers as nothing more than "supper parties" for "female physicians." And these roles, which were already constrained by gender, were made even more exclusive by the fact that they were volunteer-only. Women who didn't have access to money — many of them women of color — were barred from participating. Those who did attend made a show of their wealth. With her high-society flapper fashion, Peters was no exception.

    Whatever signs of excess she displayed when it came to clothing, however, Peters made up for in her approach to eating.

    After struggling with her weight for years early in her career, Peters lost 70 pounds by carefully restricting the amount of food she ate. Her diet was a seemingly logical extension of basic chemistry: If you want to "reduce," you need to put less energy into your body than it uses up. To do that, a unit of measure she'd applied frequently as a student of child nutrition at several Los Angeles hospitals was key. Peters and her peers had relied on calculating the caloric content of baby formula to ensure premature babies and other infants under their care were properly nourished. Now, the measure seemed an easy way to calculate the energy needs of adults.

    As a leading member of the women's club federation, Peters became a diet guru, frequently sharing bits of her dieting wisdom with fellow members. One day, shortly before leaving for her World War I service with the Red Cross, she delivered a talk about weight loss. In order for her audience to understand how she lost weight, she introduced them to the unit of measure at the foundation of her plan. The calorie, she explained, was a measure of what she called "food values."

    "You should know and also use the word calorie as frequently, or more frequently, than you use the words foot, yard, quart, gallon, and so forth, as measures of length and liquids," Peters said.

    santa_fe_hut_at_los_angeles_1918 1919_american_national_red_cross_collection_prints_and_photographs_library_of_congress_0

    Losing weight wasn't merely about meeting societal expectations, though, at least in the way Peters presented it.

    Being severely overweight was also linked with chronic illnesses such as heart and kidney disease, she wrote. At the time, it was an idea that was just beginning to circulate among scientists. More important, Peters presented calorie counting as a moral, patriotic duty. Hungry troops at the front lines, she explained, needed calories that women like her could do without. What was fat, she said, if not a high-energy resource that should be distributed to the soldiers abroad?

    "In war time it is a crime to hoard food, and fines and imprisonment have followed the exposé of such practices," Peters wrote. "Yet there are hundreds of thousands of individuals all over America who are hoarding food, and that one of the most precious of all foods! They have vast amounts of this valuable commodity stored away in their own anatomy."

    food rationing poster wwi

    Peters even went so far as to describe the discomfort of dieting as a physical reminder of American loyalty and an easier way to deal with rationing. If the food they didn't eat didn't go directly to the troops abroad, their leftovers could be used to feed their children: "That for every pang of hunger we feel we can have a double joy, that of knowing we are saving worse pangs in ... little children, and that of knowing that for every pang we feel we lose a pound."

    It may have sounded like a noble goal at first, but Peters had taken the idea of calorie counting too far.

    An imperfect science

    In a world dominated by celebrity fad diets that range from the absurd, like Reese Witherspoon's alleged "baby-food diet," to the absurdly unaffordable, such as Gwyneth Paltrow's $200 "moon dust"-infused breakfast smoothie, calories can seem like the most scientific option for improving your health. But there is more guesswork involved in calorie calculations than you might think.

    The current system of calorie counting on which our nutrition labels are based "provides only an estimate of the energy content of foods," Malden C. Nesheim, a professor of nutrition at Cornell University, said at a 2013 meeting of the nonprofit Institute for Food Technologists.

    Traditionally, scientists calculated the energy content of foods using a large piece of machinery called a bomb calorimeter. The process involved placing a sample of food into the device, burning it, and measuring how much the water in a surrounding container heated up. Since a calorie raises the temperature of a liter of water by 1 degree Celsius, the calorie count would be found by calculating the change in the water's temperature multiplied by the water's volume. Today, we use a shortcut called the Atwater system, named after agricultural chemist Wilbur Olin Atwater.

    bomb calorimeter

    Atwater — who wanted to use his work in the 1890s to help poor people get the most calories for their money— determined the average number of calories in four main energy sources: carbs, fats, protein, and alcohol. Fats, he found, were the most energy-dense with about 9 calories per gram, while proteins and carbs were roughly equal at about 4 calories per gram. Alcohol was worth about 7 calories per gram.

    The Atwater system is how the calorie counts on nutrition labels have been determined by the US Department of Agriculture since 1988. Before that, they were done by hand. Using this method, you'd be able to determine that a slice of wheat bread with 3 grams of protein, 9 grams of carbs, and 1 gram of fat had roughly 60 calories.

    Here's the problem: Not all of us process all foods the same way.

    "It's definitely not just 'calories in and calories out' because two people could be [burning] more and consuming less and one person gains and one doesn't," Cara Anselmo, a nutritionist at New York's Memorial Sloan-Kettering Cancer Center, told Business Insider. "There are metabolic differences person to person."

    These variations mean that each of us needs a different amount of energy from our food, and it can vary substantially by the day. One issue that the Atwater system will never account for, Anselmo says, is the delicate balance of hormones that guide everything from appetite to digestion. These hormones can be influenced a great deal by our previous history of weight loss or weight gain.

    "We find that with people who lose a significant amount of weight, hormones play an important role, too. So someone who's always been at 150 pounds can actually get away with eating more calories than someone who was at 250 pounds and lost 100 pounds. Your body is producing fewer of the hormones that make you feel full and more of the hormones that make you hungry," Anselmo said.

    This means that Peters, who lost a substantial amount of weight before writing her best-selling diet book, might have had to limit her diet more than someone who had always weighed what she did.

    Other factors that scientists are just beginning to understand also influence the number of calories we get from food. In a large review of studies published in the Journal of Nutrition, Purdue University scientists found that whole tree nuts and peanuts have roughly 15% fewer calories than the figure calculated using the Atwater method. Although nuts are high in fat, the researchers found, a significant portion of those oils end up being secreted when we eat them. Another study published in the British Journal of Nutrition in 2012 came to a similar conclusion about pistachios, finding that they had about 5% fewer calories than originally assumed.

    When calories aren't king

    Let's say that at lunchtime you're given two options with the same number of calories. You can either have a ham sandwich, potato chips, and a can of soda or a salad and a whole-grain roll. Which would you choose?

    You might be tempted to pick the sandwich and soda if they stack up the same in terms of calories, right?

    According to Peters and many modern diets that she influenced, the answer is yes. But it's not that simple. While counting calories can be a useful part of a bigger toolkit for weight loss, it is not a perfect solution for healthy eating, especially when used in isolation.

    Nichola Whitehead, a registered dietitian with a private practice in the UK, summarized the problem this way: "While calories are important when it comes to losing, maintaining, or gaining weight, they are not the sole thing we should be focusing on when it comes to improving our health."

    Take the following two daily meal plans, for example, both of which are about 2,000 calories:

    nutriotinal value 2000 calorie diet

    While they tally up to the same number of calories, the two plans are far from equal.

    "Both of these would give you the same number of calories, but only one of them will leave you feeling satiated and satisfied and give you the energy you need," Whitehead said.

    That's because the meal on the right doesn't provide what Whitehead refers to as "balance" — essentially the right mix of proteins, complex carbohydrates, fruits, and vegetables that your body needs to be properly fueled in the long term. Instead, that meal plan is based around refined carbohydrates, which the body breaks down quickly. Those carbs will give you a short burst of energy and make you feel full for a few hours, but probably leave you hungry before your next meal.

    "Empty calories only give a temporary fix," Whitehead said.

    avocado smoked salmon blueberries healthy food meal bowl tomatoes lunch

    To keep energy levels up and keep you full and healthy for the long term, your diet needs to feed more than your stomach. It has to satiate your muscles, which crave protein, your digestive system, which runs at its best with fiber, and your tissues and bones, which work optimally when they're getting vitamins from food.

    How we got to now, from grapefruit diets to Weight Watchers

    It wasn't until 1990 that calories made an appearance on the food we buy, and they weren't required by law until four years later.

    Before that, there was simply no way to know for sure what was in the food you bought. Several years after Peters gave her calorie talk, Spam debuted as one of the first processed convenience foods. When World War II broke out, the easy-to-eat, no-spoil food was a hit among soldiers.

    "In the universe of processed food," Anastacia Marx de Salcedo writes in "Combat-Ready Kitchen,""World War II was the Big Bang." The 1960s saw the invention of two more processed-food milestones: The first chicken nugget and high-fructose corn syrup.

    Perhaps in response to these unhealthy eating trends, severe diet fads emerged in each decade from Peters' day to the present. In the 1930s, about a decade after Polish biochemist Casimir Funk first recommended people get enough of micronutrients called "vitamines" (later found in abundance in citrus fruits and veggies), the first grapefruit diet emerged. That was followed by a banana-and-skim-milk diet promoted by United Fruit, the planet's leading banana importer. Several decades later, Weight Watchers surged in popularity, and in the 1970s, women were encouraged to take sleeping pills whenever they felt hungry. Just last summer, singer Katy Perry claimed the "M Diet," otherwise known as eating only raw mushrooms for one meal a day for two weeks, helped her lose fat in select areas of her body. 

    Throughout history, most of these diets were heavily marketed to women, and that's still true today. Nevertheless, in Peters' day, she claimed to see weight loss as a tool that she and other women could use to liberate themselves, or, in her words, to become more "efficient."

    Today, neither the mantra "calorie is king" nor the allure of fad diets appears to have won out in the global battle for our waistlines. Instead, there may be a move toward eating a more well-rounded diet based — and dietitians and public-health experts say they're encouraged by that trend.

    eating healthy

    Several recent studies suggest that whether you're looking for weight loss or to improve your health, the best eating plans are based around vegetables, whole grains, and lean proteins. These diets generally also include a variety of healthy fats, like those from nuts, fish, avocados, and olive oil. In its most report on the best eating plans, US News and World Report described vegetable-based ("plant-based") diets as "good for the environment, your heart, your weight, and your overall health."

    This means that while we can certainly use calories as a tool to guide our eating choices, we shouldn't live like Lulu Peters, focusing solely on one number.

    "Calories should be a tool for information, rather than a way to live your life," Whitehead said.

    SEE ALSO: How to lose weight if you're addicted to food, according to a cognitive scientist who struggled for years

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    • The Trump administration is moving towards allowing states to impose mandatory work requirements on their Medicaid programs. 
    • Several states including Kentucky, Michigan, and Ohio are proposing waivers that would exempt residents in counties with high unemployment rates from these work requirements. 
    • While low-income white residents of rural towns would benefit from the waivers, many low-income people of color in urban areas would not qualify. 
    • Cities with low-income people of color are often surrounded by wealthier suburbs that pull the overall county unemployment rate below the threshold to qualify. 


    As the Trump administration moves aggressively to allow more states to impose mandatory work requirements on their Medicaid programs, several states have come under fire for crafting policies that would in practice shield many rural, white residents from the impact of the new rules.

    In the GOP-controlled states of Kentucky, Michigan, and Ohio, waiver proposals would subject hundreds of thousands of Medicaid enrollees to work requirements, threatening to cut off their health insurance if they can't meet an hours-per-week threshold.

    Those waivers include exemptions for the counties with the highest unemployment, which tend to be majority-white, GOP-leaning, and rural. But many low-income people of color who live in high-unemployment urban centers would not qualify, because the wealthier suburbs surrounding those cities pull the overall county unemployment rate below the threshold.

    "This is sort of a version of racial redlining where they're identifying communities where the work requirements will be in full effect and others where they will be left out," George Washington University health law professor Sara Rosenbaum told TPM. "When that starts to result in racially identifiable areas, that's where the concern increases."

    Rosenbaum and other health law experts say the waivers — already approved for Kentucky, pending for Ohio, and advancing in Michigan's legislature — may run afoul of Title 6 of Civil Rights Act of 1964, which prohibits race-based discrimination in federal assistance programs. Under that statute, even policies that are racially neutral on their face but have a disparate impact on a particular group could be illegal.

    The waiver in Kentucky, the first state to win federal approval for a Medicaid work requirement, will have the effect of exempting eight southeastern counties where the percentage of white residents is over 90 percent. The work requirements will be imposed first in Northern Kentucky, which includes Jefferson, the county with the highest concentration of black residents in the state. The rules are set be enforced first in that area this July, but a federal court challenge in June could decide the fate of the program.

    In Michigan, the GOP-controlled legislature is trying to pass a bill to make the 700,000 people enrolled in the state's Medicaid expansion either work at least 29 hours per week or lose their benefits for a year. According to the state's own numbers, 105,000 people could lose their insurance, but that burden will not be shared equally across the state.

    People who live in counties with unemployment rates above 8.5 percent would be exempt, and those counties are overwhelmingly white, rural, and vote Republican. But low-income residents of color in Detroit and Flint, where the joblessness and poverty are extremely high, would not receive an exemption.

    A Washington Post analysis found that while African Americans make up about 23 percent of Medicaid enrollees in Michigan, they would make up just 1.2 percent of the people eligible for an exemption. Meanwhile, 57 percent of Michigan Medicaid enrollees are white, but white residents would make up 85 percent of the population eligible for an exemption.

    Ohio's Medicaid work requirement proposal — recently submitted for federal approval — is of a similar design, and would have the same disparities between urban residents of color in Cleveland and Columbus and rural white residents in the rest of the state.

    John Corlett, Ohio's former Medicaid director and the president of Cleveland's Center for Community Solutions, studied the 26 counties that qualify for an exemption from the proposed Medicaid work requirements and found they are, on average, 94 percent white. Meanwhile, his research found, "most of these non-exempted Ohio communities have either majority or significant African-American populations."

    "The communities most at risk under this scenario are African American, and those communities already have significantly higher rates of infant mortality, lower life expectancy, and a number of other serious health disparities," he told TPM.

    Additionally, Corlett noted, the racial divides within and among counties across the US are a product of decades of racist policies, and designing the exemptions on a county-by-county basis only serves to lock in those divides.

    "Our housing patterns in Ohio are influenced by a past history of institutionalized segregation, and the Medicaid waiver reinforces that instead of mitigating it," he said. "Ohio could help mitigate the racially discriminatory impact of the waiver by exempting smaller units of government — like municipalities."

    Ohio submitted its waiver to HHS the first week of May, and the policy is now under active consideration. Michigan's still needs approval from the governor, but the GOP legislature is pressuring him to sign it, even threatening to cut state officials' salaries if he fails to do so.

    Leonardo Cuello with the National Health Law Program, one of the groups bringing the federal lawsuit on behalf of Kentucky residents, told TPM that while the exemptions in these states are aimed at addressing a genuine problem — the lack of work opportunities in many areas — they are impossible to extricate from the racialized national conversation about federal assistance and work.

    "We're talking about a policy based on stereotypes about Medicaid enrollees," Cuello added, pointing to research that most non-elderly, non-disabled Medicaid recipients already work. "There is a constant dog whistle in the background here about making lazy people get off their couches and go to work, and playing into stereotypes about African Americans. It's almost impossible to argue that the policy is not racial."

    Complicating the arguments playing out in several states over carve-outs for certain Medicaid recipients is the Trump administration's ongoing internal battle over exemptions Native Americans.

    As some HHS continue to insist that exempting tribal citizens from the work requirements would be an illegal racial preference, legal experts and members of Congress warn that imposing the requirements on tribal communities violates their sovereignty.

    SEE ALSO: Kentucky's governor threatens to take coverage away from close to 500,000 people if his huge Medicaid changes are blocked

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    • President Donald Trump and Republicans have so far failed to pass large-scale bills to undo former President Barack Obama's legislative achievements, such as Obamacare.
    • But Trump and the GOP have found ways to chip away at Obama's legacy.
    • Most recently, that came in the form of the Wall Street deregulation bill passed Tuesday.
    • It eliminates some — but not all — of the Dodd-Frank Act's banking rules.
    • Trump and Republicans have also used regulatory actions to shape the healthcare system and other federal agencies.

    Congress' passage Tuesday of the first major rollback of Wall Street regulations enacted after the financial crisis are set to not only reshape the financial system, but also serve as the latest Republican blow in a bid to unwind former President Barack Obama's legacy.

    The bill, which President Donald Trump says he will sign, does not undo the post-crisis banking regulation Dodd-Frank Act completely. But it is set to roll back many of the rules and regulations that came to define Obama's relationship to Wall Street.

    Sen. Mitch McConnell, the majority leader, said the legislation would give "smaller community lenders relief from Obama-era overregulation."

    "I frequently discuss how our Democratic colleagues' top-down policy agenda worked well for a select few urban areas but left much of the rest of the nation behind. This issue is a perfect illustration of that," he said.

    Congress has so far had trouble with big swings at undoing Obama's legislative legacy. Obamacare repeal failed, and Dodd-Frank is nowhere close to the full unraveling the GOP promised in 2010.

    But at the margins, the Trump administration and GOP lawmakers have managed to chip away at some of the former president's signature accomplishments.

    Trump attacks Obama's agenda on all fronts

    Trump has undertaken extensive reversal to his predecessor's legacy through executive order. Most significantly, he has done so by pulling the the US out of the Iran nuclear deal, the Paris climate agreement, the Trans-Pacific Partnership, three major, multilateral deals.

    But Congress and the administration have also used other parliamentary and regulatory tactics to slowly but surely hack away at the former president's policy achievements.

    One of the biggest examples has come from Trump administration's major changes to the healthcare system, despite multiple high-profile botched attempts to repeal and replace Obamacare.

    Republicans also slipped a monumental Obamacare change into their recently implemented tax bill. Starting next year, individuals will no longer face the law's individual mandate— the rule that requires all American get health coverage or face a fine.

    While the mandate will allow some people to avoid paying the penalty, the Congressional Budget Office estimated the repeal will result in 13 million more Americans going uninsured by 2027 compared to the current system.

    Obama doctors Obamacare

    The Trump administration has also worked to reshape healthcare rules on the state and national level:

    • The Department of Health and Human Services has been aggressive in approving waivers that allow states to make modifications to Medicaid programs and insurance market regulations.
    • These waivers are designed to help states bring down costs for consumers, but the waivers granted so far also undermine some of Obamacare's regulations for health plans and possibly reduce the number of poor Americans on Medicaid.
    • On the national level, the department is set to roll out an expansion of short-term health plans that could allow insurers to dodge some of the healthcare law's key protections.
    • These plans are not subject to the same regulatory scrutiny as long-term plans, making them a cheaper but much less generous option. Healthy policy analysts warn that people on these plans could be subject to higher costs in the event of illness and the expanded use of short-term plans will undermine the main Obamacare market.

    Other agencies, such as the Environmental Protection Agency, Department of the Interior, and Department of Housing and Urban Development are making similar rule changes to reverse Obama-era practices.

    Congress uses an unusual route to chip away

    In Congress, Republicans have also made use of the Congressional Review Act, which allows lawmakers to rescind regulations put in place by executive agencies. Recently, Republicans also tried an unused wrinkle to the CRA, which could allow Congress to rescind regulations dating back to the CRA's passage in 1996.

    Previously, the CRA was thought to only apply to regulations that were created within the past 60 days. But, the GOP pointed a small provision that says the CRA can be used for up to 60 days after a regulation is submitted to Congress. Since many regulations were not submitted, Republicans have argued they have even more leeway to continue to undo Obama's executive actions and regulations with very little effort.

    Republicans were able to block a 2013 rule from the Consumer Financial Protection Bureau that attempted to prevent racial discrimination in auto lending. More could be on the way.

    "By setting this terrible precedent of repealing regulatory guidance, the majority is opening up a Pandora’s Box that could have deeply harmful consequences for the public and badly impede the important work of regulators not just of the financial services industry, but of all industries," Rep. Maxine Waters, the top Democrat on the House Financial Services Committee, said at the time.

    SEE ALSO: Congress quietly passed the largest rollback of Wall Street regulations since the financial crisis

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    • Republicans repealed Obamacare's individual mandate in their tax reform law, which President Donald Trump said was effectively a repeal of Obamacare.
    • A new Congressional Budget Office report shows that fewer people will leave the Obamacare market due to the mandate repeal than previously thought.
    • Part of the reason, the CBO said, was because people value health coverage more than before Obamacare was passed.

    Even after sustaining a major blow from Republicans, Americans may not ditch Obamacare as quickly as previously thought.

    The new GOP tax reform law contained a provision that virtually eliminated Obamacare's individual mandate, which requires all Americans to purchase health coverage or face a penalty. After Congress passed the tax law, Trump claimed that getting rid of the mandate amounted to a "repeal" of the landmark healthcare law.

    Trump's language was a bit strong — the mandate is only one element of Obamacare — but the Congressional Budget Office estimated in November that 13 million more Americans would end up uninsured by 2027 than under the current baseline. 

    Six months later, a CBO update found that the mandate repeal would only cause about 5 million more people to go uninsured in that timeframe. There are several reasons for the adjustment, including insurance market changes and methodology tweaks.

    While those changes were more technical in nature, the CBO also mentioned an interesting shift that helped cause the drop: people like having health insurance.

    "The mandate has been in place for an additional year (five years in total), and people’s expectations about whether one should have coverage are more established and, in CBO’s current judgment, less sensitive to repealing the legal mandate," the report said.

    Put another way, Obamacare prompted millions of American to get health coverage for the first time — and a good portion don't want to give up what they've bought.

    Recent polling also appears to confirm that many Americans plan to stick with their coverage despite the mandate repeal.

    The Kaiser Family Foundation, a nonpartisan health policy think tank, found in a March poll that 90% of people currently enrolled in a plan purchased on the Obamacare marketplace planned to keep their coverage even when the penalty disappears in 2019. Just 7% of people who had these plans told Kaiser they planned to drop the coverage.

    The Kaiser also poll found that most people didn't consider the mandate to be a big reason for their insurance purchase. Just 34% of those surveyed said the law's requirement to buy coverage was a "major reason" they decided to sign up.

    This could, of course, change over time based on factors like the cost of coverage.

    In the report, the CBO also estimated that premiums on the Obamacare individual insurance market would increase by 15% in 2019 and 7% each year afterward through 2027.

    SEE ALSO: The GOP just dealt another blow in their steady unraveling of Obama's legacy

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    • The Virginia Senate approved a state budget that includes Medicaid expansion under the Affordable Care Act, or Obamacare.
    • A final vote in the House is needed, but the move would make Virginia the 33rd state to approve Medicaid expansion.
    • The potential is an example of Obamacare's resiliency despite GOP attempts to repeal the law.

    Virginia's state Senate voted Wednesday in favor of a plan that would expand the state's Medicaid program under the Affordable Care Act, or Obamacare, in a move that shows the resiliency of the landmark healthcare law.

    The Virginia Senate voted 23 to 17 to pass a budget that included Medicaid expansion, which could extend healthcare coverage to roughly 400,000 low-income Virginians.

    The House must re-ote on the Senate package, but a similar measure already made it through that chamber and the second vote is expected to follow suit.

    The move would make Virginia the 33rd state to approve Medicaid expansion. Washington, DC, also expanded the program, and while Maine citizens voted for expansion in 2017, GOP Gov. Paul LePage has refused to implement it.

    The move is the culmination of five years of back-and-forth on Medicaid expansion in the state.

    GOP Gov. Bob McDonnell turned down the expansion in 2013. Former Democratic Gov. Terry McAuliffe, who was elected in 2014, attempted multiple times but was ultimately unable to convince the GOP-controlled legislature to approve a expansion measure.

    But after devastating electoral losses in 2017 that substantially reduced the Republican majorities in both the House and Senate, a handful of Virginia Republicans came around on the issue. Newly elected Democratic Gov. Ralph Northam added extra pressure when he told legislators that he would not sign a state budget that did not include Medicaid expansion.

    While Democrats secured a large victory, the final bill does include a caveat. The bill also institutes a work requirement for the Medicaid program, which compels recipients to work or volunteer for at least 20 hours a month to get benefits. The minimum number of hours a month would steadily increase while the person was on Medicaid before topping out at 80 hours a month after a year.

    The Senate-approved plan would also require people making above the federal poverty limit to pay more for out-of-pocket care, another Republican request.

    Democrats nearly universally opposed the idea, but it was a requirement for many Republican members to get on board with expansion. In theory, such a provision could be repealed if Democrats gains a firm advantage in the legislature.

    The Virginia vote comes at a crucial vote for Medicaid expansion and the broader ACA in general.

    In addition to the Commonwealth state, proponents in three other states are attempting to pass measures to expand the program. A ballot measure in Utah will allow voters to decide on the issue, while activists in Idaho and Nebraska are collecting signatures for similar ballot measures in those states. Reclaim Idaho, the group pushing for expansion in that state, said the group received enough signatures to secure a ballot measure.

    For the broader ACA, the popularity of the Medicaid expansion underscores the continued resiliency of the law despite the GOP's attempts to repeal the legislation. In addition, a Kaiser Family Foundation poll in April 2018 found that 49% of American held a favorable view of Obamacare while 43% viewed the law unfavorably.

    SEE ALSO: China is ramping up talk of a trade war, and it could come back to blow up in Trump's face

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    • On Thursday, the US Justice Department proclaimed that the part of the Affordable Care Act requiring people to have health insurance was unconstitutional.
    • This also extends to two major provisions of the ACA, also known as Obamacare, including one that protects people with preexisting conditions from being denied coverage.
    • A coalition of 20 states led by attorneys from Texas and Wisconsin sued the government in February for the repeal of the Obamacare provisions.
    • Attorney General Jeff Sessions said the Justice Department would not defend the preexisting-conditions provision or the provision allowing insurance companies to impose discriminatory pricing.

    WASHINGTON — The US Justice Department on Thursday said the part of Affordable Care Act requiring people to have health insurance is unconstitutional, an unusual move that could lead to stripping away some of the most significant and popular parts of the law, better known as Obamacare.

    In a brief filed in a federal court in Texas, the department said a tax law signed last year by President Donald Trump that eliminated penalties for not having health insurance rendered the so-called individual mandate under Obamacare unconstitutional.

    The Justice Department said that also nullified two other major provisions of Obamacare linked to the individual mandate, including one barring insurance companies from denying coverage to people with preexisting conditions.

    Attorney General Jeff Sessions, in a letter to House Speaker Paul Ryan, said he had determined the individual mandate would be unconstitutional when the tax law takes effective in 2019.

    The mandate in Obamacare was meant to ensure a viable health-insurance market by forcing younger, healthier Americans to buy coverage.

    The Justice Department rarely declines to argue in favor of existing law in court, and this decision will put pressure on the Affordable Care Act, which was President Barack Obama's signature domestic achievement.

    A coalition of 20 US states sued the federal government in February, claiming the law was no longer constitutional after last year's repeal of the penalty that individuals had to pay for not having insurance.

    Led by Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel, the lawsuit said that without the individual mandate, Obamacare in its entirety was unlawful.

    Sessions said in his letter that the Justice Department was not arguing that the entire law did not pass constitutional muster. He said the department refused to defend only the preexisting-conditions provision as well as one forbidding insurers from charging people in the same community different rates based on gender, age, health status, or other factors.

    Trump and fellow Republicans in Congress have sought to dismantle Obamacare, which sought to expand insurance coverage to more Americans.

     

    (Reporting by Eric Beech and Lisa Lambert; Editing by Leslie Adler)

    SEE ALSO: From acne to pregnancy, here's every 'preexisting condition' that could put your insurance at risk under the Senate's healthcare bill

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    • President Donald Trump nominated Brett Kavanaugh to replace Justice Anthony Kennedy on the Supreme Court.
    • Experts and politicians are questioning how Kavanaugh could rule on cases involving Obamacare.
    • Some conservatives say Kavanaugh will not go far enough to dismantle Obamacare, citing a dissent from 2011, while other conservatives believe the judge would rule against the law.
    • Democrats and liberals are almost all fearful of Kavanaugh's possible rulings on Obamacare.

    President Donald Trump's nomination of Brett Kavanaugh to replace Justice Anthony Kennedy on the Supreme Court has legal scholars and politicians carefully parsing the judge's previous decisions for clues about the future of US policy.

    One of the biggest issues on which Kavanaugh is expected to have a say is the future of the Affordable Care Act, or Obamacare. The landmark healthcare law has been the subject of a series of intense legal battles, and many observers expect more decisions on the ACA's future to make it to the Supreme Court during Kavanaugh's tenure.

    Given Kavanaugh's conservative bent, many Democrats are up in arms about the future of Obamacare should the judge be confirmed. But conservatives are also concerned about the future of the law under Kavanaugh.

    Conservative concerns

    The crux of the conservative disagreement over Kavanaugh's Obamacare record comes from a single decision in 2011.

    When ruling on Seven-Sky v. Holder, Kavanaugh dissented from the majority opinion that the law's individual mandate — which compelled every American to have health insurance or face a fine — was constitutional.

    According to conservative healthcare expert Chris Jacobs and other conservative writers, the reason behind Kavanaugh's dissent opened the door to solidifying the ACA's legal footing.

    "Even as he avoided a definitive ruling on the merits of the case, Kavanaugh revealed himself as favorably disposed to the mandate," Jacobs wrote at The Federalist. "Worst of all, in so doing, he cultivated a theory that ultimately led Chief Justice John Roberts to uphold the mandate."

    In essence, Kavanaugh argued that he could not rule on the case because the Anti-Injunction Act of 1867 did not allow judges to rule on the legality of a tax before it was imposed. Since the mandate did not kick in until 2014, he wrote, the court could not render an opinion.

    Brett Kavanaugh TrumpJacobs wrote that Kavanaugh's use of the century-and-a-half-old law validated the Obama administration's argument before the Supreme Court that the mandate was legal since it was a tax. 

    Combined with other sections of the dissent, Jacobs said Kavanaugh gave the "road map" for the Obama administration's legality argument and Roberts's decision.

    But other conservatives reject Jacobs's suggestion that Kavanaugh's dissent presented a legal basis to uphold the ACA by pointing to other sections of his argument.

    In the dissent, Kavanaugh said the mandate was "a law that is unprecedented on the federal level in American history" and called the penalty for people not buying insurance "jarring."

    Justin Walker, a law professor at Louisville University and a former clerk for both Kavanaugh and Kennedy, wrote that the dissent was ultimately more an argument against the mandate than in favor.

    "Kavanaugh’s thorough and principled takedown of the mandate was indeed a roadmap for the Supreme Court — the Supreme Court dissenters, justices Antonin Scalia, Anthony Kennedy, Clarence Thomas, and Samuel Alito, who explained that the mandate violated the Constitution," Walker said.

    Liberals worry Kavanaugh puts 'healthcare protections in jeopardy'

    While conservatives debated the semantics of Kavanaugh's decision, Democrats and liberal activists were overwhelmingly alarmed by the nomination.

    "Judge Kavanaugh should not be allowed anywhere near our nation’s highest bench," a post on the Democratic Party's official blog said. "Let’s be clear: a vote for Kavanaugh would be a vote to rip health care from American families and deny women their constitutional right to make their own health care decisions."

    Democrats and pro-ACA activists are worried Kavanaugh could weaken key tenants of the ACA, given new legal challenges to the underlying thesis of the law.

    While experts are dubious the new challenges have standing, in no small part because Chief Justice John Roberts sided with the liberal members of the court in 2012 to uphold the law, Democratic senators have hinted healthcare will be a core piece of their opposition to Kavanaugh's nomination.

    "He’s demonstrated a hostility to the Affordable Care Act that the Trump administration is continually working to undermine," Democratic Sen. Booker said in a statement following the nomination announcement.

    Senate Minority Leader Chuck Schumer said during a press conference on the steps of the Supreme Court on Tuesday that Kavanaugh's selection would put healthcare protections in the ACA, such as protections for people with preexisting conditions, "at grave, grave risk" and said people should demand a justice to "protect our healthcare, not strike it down."

    SEE ALSO: Brett Kavanaugh is the latest high-level Trump appointee to come from a single Washington, DC-area high school

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    • The Trump administration is rolling out a new proposal to expand the use of short-term health insurance plans.
    • The plans would be a cheaper insurance option, but also offer limited coverage and could lead to denied coverage based on a preexisting condition.
    • Health policy experts say the Trump administration's move will weaken the Affordable Care Act.
    • The short-term plan expansion is another step in Trump's plan to reshape the healthcare system without repealing Obamacare.

    President Donald Trump's plan to reshape Obamacare without repealing the law continued Wednesday, as his administration rolled out its final plan to expand the use of skinny, short-term health insurance coverage.

    The Centers for Medicare and Medicaid Services, or CMS, released a final rule that will expand short-term health insurance plans, a move that the administration said will help more people access cheap insurance options.

    "We continue to see a crisis of affordability in the individual insurance market, especially for those who don’t qualify for large subsidies," CMS Administrator Seema Verma said in a statement. "This final rule opens the door to new, more affordable coverage options for millions of middle-class Americans who have been priced out of ACA plans."

    But many health policy experts say the plans will offer severely limited coverage and could drive up costs for people who remain in the Affordable Care Act market.

    What are short-term plans?

    Prior to the Trump administration's new rule, short-term plans were available for only three months with strict limitations on renewals.

    Under the ACA, these plans were designed as a bridge to help people maintain coverage after a job loss or other change in insurance until the next enrollment period for longer-term plans under Obamacare.

    The CMS rule released Wednesday will allow people to stay on a short-term health insurance plan for just under 12 months and make it easy to renew the plan for a total of three years.

    Short-term plans are cheaper than ACA plans. CMS said the average short-term plan cost $124 a month in 2016 versus roughly $400 a month for an Obamacare plan. But that lower cost comes with another price.

    Obama doctors Obamacare

    Insurers do not have to abide by the ACA's regulations when offering short-term plans, meaning they can deny claims and charge patients higher premiums based on preexisting conditions.

    The plans do not have to meet Obamacare's baseline coverage minimums, so things like prescription drugs or maternity care may not be covered under these plans.

    According to the Kaiser Family Foundation, a nonpartisan health policy think tank:

    • 0% of the short-term insurance plans currently on the market offer maternity care coverage.
    • Just 29% cover prescription drug costs.
    • 57% cover mental health needs.

    Only 106,000 people were on short-term health plans at the end of 2016, according to the administration. But an analysis by the Congressional Budget Office estimated that number could grow to as much as 1.6 million in the next four years under the new rule.

    What does this mean for Obamacare?

    Larry Levitt, a senior vice president at Kaiser, said the expansion of short-term health plans would help provide some relief for some healthy people — but at the expense of others in the Obamacare markets.

    "Plans with ACA consumer protections will still exist," Levitt tweeted Wednesday. "But, the premiums for those plans will rise as short-term plans cherry pick healthy people. ACA enrollees eligible for subsidies will be protected, but middle-class people with pre-existing conditions will feel the full brunt."

    As more healthy people hop on cheaper short-term plans, the overall make-up of the ACA markets will be sicker and more expensive to cover for insurers. In turn, experts say, insurers will raise premiums to compensate for the increased average cost.

    While most people in the ACA market will be shielded from the increases through federal premium subsides, those middle-class families in the market that do not receive subsides will bear the brunt of the higher costs.

    doctor patient

    Short-term plans have also been a source of headaches for enrollees. As Bloomberg has reported, many short-term plan enrollees have been hit with unexpected costs and denied coverage when seeking benefits. These issues have led to a large number of customer complaints — and the plans being banned completely in some states.

    Short-term plans represent the latest step in the Trump administration's aim to reshape the healthcare system despite the failure of the GOP's attempts to completely repeal Obamacare:

    • Republicans were able to repeal the individual mandate, a key piece of Obamacare that required people to sign up for health insurance or face a penalty, as part of the GOP tax law.
    • CMS and the Department of Health and Human Services approved waivers to allow states to impose work restrictions for people on Medicaid (this remains subject to legal challenges) and slashed funding that would advertise Obamacare plans. 

    SEE ALSO: A study already threw cold water on the biggest argument for Trump's $100 billion tax cut

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    • The Trump administration is reportedly preparing to roll out new rules that will make it harder for immigrants to receive green cards or become citizens if they have used common public programs like Obamacare.
    • Under current rules, immigrants are only questioned about their use of cash welfare programs and conditions like severe illnesses that could hinder their abilities to provide for themselves.
    • The Homeland Security department said any new rules that are implemented will ensure that immigrants are "self-sufficient."

    The Trump administration is reportedly preparing new rules that would limit green cards and citizenship for immigrants who live in the US legally and use programs like Obamacare, food stamps, or children's health insurance.

    Though rumors and drafts of the new rules have been circulating throughout the media since February, NBC News reported Tuesday that the Trump administration is finalizing the proposals and will likely roll them out in the coming weeks.

    According to NBC, the chief architect of the new rules is Stephen Miller, the White House senior adviser and immigration hardliner who has become the face of President Donald Trump's crackdown on both illegal and legal immigration.

    A Homeland Security representative told NBC in a statement that any proposed changes will ensure that the government is responsibly administering taxpayer funds.

    "The administration is committed to enforcing existing immigration law, which is clearly intended to protect the American taxpayer by ensuring that foreign nationals seeking to enter or remain in the US are self-sufficient," the statement said.

    stephen miller

    By changing the rules, the Trump administration would essentially widen the definition of "public charge," a term that applies to immigrants the government deems are a burden to taxpayers without contributing to the economy.

    Under the current rules dating back to 1999, a public charge is an immigrant who uses or has previously used cash welfare programs like Supplemental Security Income, and who may either be elderly, sick with an illness requiring expensive treatment, low-income, low-skilled, or with few family members to provide support.

    But the new rules the Trump administration is proposing would also consider usage of popular non-cash programs, including certain health, education, and housing benefits, according to an early draft Vox obtained in February.

    Immigration lawyers and advocates have condemned the draft proposals for the new rules and said they have already begun warning their clients seeking to switch from green cards to citizenship.

    "Any policy forcing millions of families to choose between the denial of status and food or health care would exacerbate serious problems such as hunger, unmet health needs, child poverty, and homelessness, with lasting consequences for families' wellbeing and long-term success," the National Immigration Law Center told NBC in a statement.

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    • Millions of people covered under the Affordable Care Act will see only modest premium increases next year and some will get price cuts, according to a new study.
    • The study found a 3.6 percent average increase in proposed or approved premiums across 47 states and Washington, D.C. for next year, compared to the average increase nationally of about 30 percent this past year.

    WASHINGTON (AP) — Millions of people covered under the Affordable Care Act will see only modest premium increases next year, and some will get a price cut.

    That's the conclusion from an exclusive analysis of the besieged but resilient program, which still sparks deep divisions heading into this year's midterm elections.

    The consulting firm Avalere Health and The Associated Press crunched available state data and found that "Obamacare's" health insurance marketplaces seem to be stabilizing after two years of sharp premium hikes.

    And the exodus of insurers from the program has halted, even reversed somewhat, with more consumer choices for 2019.

    The analysis found a 3.6 percent average increase in proposed or approved premiums across 47 states and Washington, D.C., for next year. This year the average increase nationally was about 30 percent. The average total premium for an individual covered under the health law is now close to $600 a month before subsidies.

    For next year, premiums are expected either to drop or increase by less than 10 percent in 41 states with about 9 million customers. Eleven of those states are expected to see a drop in average premiums. In six other states, plus Washington, D.C., premiums are projected to rise between 10 percent and 18 percent.

    U.S. President Barack Obama signs the Affordable Care Act, dubbed Obamacare, the comprehensive healthcare reform legislation during a ceremony in the East Room of the White House in Washington, U.S., March 23, 2010. REUTERS/Jason Reed/File Photo

    Insurers also are starting to come back. Nineteen states will either see new insurers enter or current ones expand into more areas. There are no bare counties lacking a willing insurer.

    Even so, Chris Sloan, an Avalere director, says, “This is still a market that’s unaffordable for many people who aren’t eligible for subsidies.”

    Nearly 9 in 10 ACA customers get government subsidies based on income, shielding most from premium increases. But people with higher incomes, who don’t qualify for financial aid, have dropped out in droves.

    It’s too early to say if the ACA’s turnabout will be fleeting or a more permanent shift. Either way, next year’s numbers are at odds with the political rhetoric around the ACA, still heated even after President Donald Trump and congressional Republicans failed to repeal the law last year.

    Trump regularly calls “Obamacare” a “disaster” and time again has declared it “dead.” The GOP tax-cut bill repealed the ACA requirement that Americans have health insurance or risk fines, effective next year.

    But other key elements remain, including subsidies and protection for people with pre-existing conditions. Democrats, meanwhile, accuse Trump of “sabotage,” driving up premiums and threatening coverage.

    The moderating market trend “takes the issue away from Republican candidates” in the midterm elections, said Mark Hall, a health law and policy expert at Wake Forest University in North Carolina. “Part of the mess is now their fault, and the facts really don’t support the narrative that things are getting worse.”

    Market stability also appears to undercut Democrats’ charge that Trump is undermining the program. But Democrats disagree, saying the ACA is in danger while Republicans control Washington, and that premiums would have been even lower but for the administration’s hostility.

    “Voters won’t think that the Trump threat to the ACA has passed at all, unless Democrats get at least the House in 2018,” said Bill Carrick, a strategist for Sen. Dianne Feinstein, D-Calif., whose re-election ads emphasize her support for the health law.

    As if seconding Democrats’ argument, the Trump administration has said it won’t defend the ACA’s protections for pre-existing conditions in a federal case in Texas that could go to the Supreme Court.

    A new Kaiser Family Foundation poll found that Americans regardless of partisan identification said those protections should remain the law of the land.

    In solidly Republican Arkansas, Democratic state legislator and cancer survivor Clarke Tucker is using the ACA in his campaign to try to flip a U.S. House seat from red to blue.

    Tucker, 37, says part of what made him want to run is the House vote to repeal the ACA last year and images of Trump and GOP lawmakers celebrating at the White House.

    Obama doctors Obamacare

    Business analysts say the relatively good news for 2019 is partly the result of previous premium increases, which allowed insurers to return to profitability after losing hundreds of millions of dollars.

    “They can price better, and they can manage this population better, which is why they can actually make some money,” said Deep Banerjee of Standard & Poor’s.

    Repeal of the ACA’s requirement to carry insurance doesn’t seem to have had a major impact yet, but Banerjee said there’s “a cloud of uncertainty” around the Trump administration’s potential policy shifts.

    Yet some administration actions have also helped settle the markets, such as continuing a premium stabilization program.

    April Box of Spokane Valley, Washington, lives in a state where premiums could rise substantially since insurers have proposed an 18 percent increase. In states expecting double-digit increases, the reasons reflect local market conditions. Proposed increases may ultimately get revised downward.

    Box is self-employed as a personal advocate helping patients navigate the health care system. She has an ACA plan, but even with a subsidy her premiums are expensive and a high deductible means she’s essentially covered only for catastrophic illness.

    “I’m choosing not to go to the doctor, and I’m saying to myself I’m not sick enough to go to the doctors,” Box said. “We need to figure out how to make it better and lower the price.”

    Now in her 50s, Box was born with dislocated hips. She worries she could be uninsurable if insurers are allowed to go back to denying coverage for pre-existing conditions. She might need another hip surgery.

    “It needs to be a level playing field for everybody,” said Box. “We need to have universal coverage — that is really the only answer.”

    Tennessee is a prime example of the ACA’s flipped fortunes.

    Last year, the state struggled to secure at least one insurer in every county. But approved rates for 2019 reflect an 11 percent average decrease. Two new insurers — Bright Health and Celtic— have entered its marketplace, and two others —Cigna and Oscar— will expand into new counties.

    Tennessee Republican Sen. Lamar Alexander called that a “welcome step,” but argued rates could have been even lower if congressional Democrats had supported a market stabilization bill. Democrats blame Republicans for the failure.

    To calculate premium changes, Avalere and The Associated Press used proposed overall individual marketplace rate filings for 34 states and D.C., and final rates for 13 states that have already approved them. Data was not available for Massachusetts, Maryland and Alabama.

    The average rate change calculations include both on-exchange and off-exchange plans that comply with ACA requirements. The government isn’t expected to release final national figures until later this fall.

    SEE ALSO: REVEALED: Trump's 10-step plan to dismantle Obamacare

    DON'T MISS: Obamacare sign ups are crushing their pace from last year — but there's still a huge problem

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    • The percentage of Americans without health insurance remained steady at 8.8% in 2017, according to the Census Bureau.
    • The flat rate was the first time since 2010 that the number of uninsured did not fall since the Affordable Care Act's passage in 2010.
    • The Census also showed a growing divide between states that took advantage of Obamacare's Medicaid expansion and those that declined the expansion.

    The percentage of Americans without health insurance did not decline on 2017, marking the first time since the passage of the Affordable Care Act that the uninsured rate held steady.

    According to the Census Bureau28.5 million Americans, or 8.8% of the population, went without health coverage in 2017. That number was a slight increase from the 28.1 million Americans without insurance in 2016, though the rate of 8.8% was consistent. The Census Bureau said the increase was not statistically significant.

    The Census report also confirmed the growing chasm between states that decided to take advantage of the ACA's Medicaid expansion and those that did not.

    The ACA, better known as Obamacare, allowed states to expand Medicaid coverage to people making up to 138% of the federal poverty line. Since then, 31 states and Washington, DC, have adopted the expansion.

    "In states that expanded Medicaid eligibility ('expansion states'), the uninsured rate in 2017 was 6.5%, compared with 12.2% in states that did not expand Medicaid eligibility ('non-expansion states')," the Census Bureau said in the report.

    In fact, the uninsured rate in states that did not expand Medicaid went up 0.7 percentage points compared to the stable rate in states that did expand Medicaid. Since 2013, the uninsured rate in expansion states is down 7 percentage points, compared to just 5.3 percentage points in non-expansion states.

    Screen Shot 2018 09 12 at 3.42.53 PM

    The flat uninsured rate came in President Donald Trump's first full year in office. Throughout the year, Republicans and the Trump administration attempted to dismantle Obamacare, though multiple bids to repeal and replace the ACA failed.

    The administration did take actions that many experts said would destabilize Obamacare's individual insurance marketplaces, including reducing outreach to get people to sign up for plans.

    Perhaps most significantly, Republicans repealed Obamacare's individual mandate— the requirement that all Americans get insurance or face a monetary penalty — as part of their tax bill.

    Some experts blamed the stall on the meddling by the Trump administration and GOP.

    Matt Broaddus, a senior research analyst at the left-leaning Center of Budget and Policy Priorities, pointed to the studies that showed a large swath of the uninsured are eligible for cheap coverage under the ACA as evidence that the uncertainty and lack of outreach were the cause of the stall.

    "Last year’s sabotage efforts likely prevented additional coverage gains by creating barriers to obtaining available and affordable coverage,"Broaddus wrote. "Roughly 55% of the uninsured are eligible for health insurance coverage with financial assistance under the ACA or other public programs, the Kaiser Family Foundation and the Urban Institute find."

    Phillip Klein, the managing editor of the Washington Examiner and conservative healthcare analyst, argued that the stability of the uninsured rate proved that Democrats claims that Trump "sabotaged" Obamacare are overblown.

    "Had there been a significant dip, it would have bolstered Democrats' case,"Klein wrote. "Now Republicans can argue that despite all of the apocalyptic warnings, the uninsured rate is the same under Trump as it was under Obama."

    "Various actions of the Trump administration, such as slashing the ad and outreach budget for Obamacare and ending certain payments to insurers, have been used by Democrats to charge that the Trump administration has launched a concerted effort to sabotage the law. But that is not visible in the numbers," he said.

    Larry Levitt, senior vice president at the Kaiser Family Foundation, a nonpartisan healthcare think tank, said the new data is inconclusive to make a determination either way.

    "Progress in reducing the uninsured rate was already stalled, pre-Trump," Levitt tweeted Wednesday. "Increases in the number of people uninsured could come this year and next, as changes to the ACA from the Trump administration and Congress take hold."

    SEE ALSO: Trump's trade war with China is still raging — here are the states that could end up getting whacked

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    • Senate Democrats forced a vote to roll back the Trump administration's new rule expanding the use of short-term, limited-duration health insurance plans on Wednesday.
    • Short-term, limited-duration plans are cheap alternatives to Obamacare marketplace plans.
    • But they lack key protections for Americans with preexisting conditions.
    • Democrats say the expanded use of short-term plans would harm people with preexisting conditions, while the GOP argue expanding the plans gave consumers more choice.
    • The vote ultimately failed, but bringing the preexisting condition issue to the forefront could still be a win for Democrats.

    Senate Democrats failed to push through a key healthcare vote on Wednesday, but in defeat looked toward a boost in their midterm election prospects.

    Sen. Tammy Baldwin used a procedure called a discharge petition to force a vote that would have repealed President Donald Trump's plan to expand short-term, limited-duration health insurance plans — which Democrats called "junk" plans.

    The petition ultimately failed in the Senate by a vote of 50-50, with GOP Sen. Susan Collins crossing party lines to vote with Democrats.

    But Democrats may still have gotten a big win from the vote.

    In the run up to the midterm elections, Democrats are hammering the GOP on healthcare — particularly protections for people with preexisting conditions. And the stark divide between the two parties in the petition vote could give add another wrinkle to the fight.

    Preexisting condition protections vs. consumer choice

    The discharge petition was designed to roll back a regulatory change from Trump's Department of Health and Human Services. The rule change allowed the expanded use of short-term, limited-duration health insurance plans.

    These plans are cheaper but also less generous in what they cover. Under the Affordable Care Act, or ACA, the use of short-term plans was limited to three months and were generally used by people as a bridge in case of a job loss.

    The new Trump rule would allow Americans to stay on the short-term plans for up to 12 months and allow renewals for up to three years.

    Health policy experts say the problem with these plans is that they do not have to abide by the ACA's basic coverage rules:

    • This means that while insurers can't deny people short-term plans based on a preexisting condition, they can charge more for people who are sick and possibly even price those people out of the market.
    • The short-term plans do not need to abide by the ACA's essential health benefits rules, which force all insurance plans to offer baseline coverage like prescription drug payments and maternity care.
    • Experts warn that the short-term plans could pull healthier, younger people out of the ACA market. That would leave a more expensive pool of people in the Obamacare marketplace, potentially pushing up prices for everyone.

    Obama doctors Obamacare

    Democrats argued the expansion of these plans will undermine preexisting condition protections and harm sicker Americans.

    Sen. Joe Manchin, a moderate Democrat facing a tough reelection race in West Virginia, supported the petition.

    "I am fighting to ensure that every West Virginian with preexisting conditions, and those who may someday have a pre-existing condition, cannot be denied healthcare coverage or be charged more for their coverage," Manchin said in a statement after the vote.

    While Democrats hammered the issue as a vote on preexisting conditions protections, Republicans cast the discharge petition in a very different light.

    To Republicans, the short-term healthcare plans were about consumer choice. 

    "We don’t need more command and control, more paternalism out of Washington that thinks it knows what’s best for you," said Sen. John Cornyn, the second-highest ranking Republican. "We need more choices for consumers so they can buy healthcare at a price they can afford and that suits their needs."

    Others like Sen. Ron Johnson argued that the short-term plans do not undermine Obamacare's preexisting condition protections.

    "The rule expands affordable options and leaves Obamacare plans’ pre-existing conditions provisions untouched," Johnson said.

    While it is true that the plans don't eliminate the ACA's preexisting conditions provisions, it would undermine them for people on the plans. According to the Congressional Budget Office, 1.6 million in the first four years under the rule would be on those types of plans without protections.

    Collins, the lone GOP vote for the petition, framed preexisting conditions as the decisive factor in her vote.

    "Short-Term Limited Duration plans do not provide protections for enrollees who suffer from preexisting conditions," Collins said. "As I have often emphasized, it is essential that individuals who suffer from preexisting conditions are covered."

    A political winner?

    Polling shows that protections of people with preexisting conditions are important to voters.

    According to a poll by the Kaiser Family Foundation, a nonpartisan health policy think tank:

    • 75% of people surveyed said protections to ensure people are not denied coverage due to a preexisting condition are "very important."
    • 72% said ensuring people are not charged more because of preexisting conditions is very important.
    • 56% of Republicans polled by Kaiser said protecting sick people from being charged more from insurance was important.
    • Another poll, from Morning Consult and Politico, found that 81% of voters said that it should be illegal for insurers to deny people coverage due to a preexisting condition.
    • 71% said it should be illegal for insurers to charge more.

    And more people said they trusted the Democratic Party to ensure those protections: 42% of people surveyed by Morning Consult/Politico said that they trust Democrats to protect people with preexisting conditions, while only 20% preferred Republicans.

    It's obvious Democrats know their advantage. Roughly half of all ad spending by Democratic midterm candidates or groups focuses on healthcare, far and way the largest focus for the party.

    SEE ALSO: A bipartisan pair of senators want more answers from the company accused of selling Apple and Amazon data servers compromised by Chinese spies

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    • Senate Majority Leader Mitch McConnell said the GOP would take another shot at repealing Obamacare if the party kept control of Congress this fall.
    • McConnell called the failure to repeal Obamacare "the one disappointment of this Congress from a Republican point of view."
    • Democrats are hammering Republicans on healthcare in the lead up to the midterms, as the GOP's repeal and replace plans proved unpopular.

    Senate Majority Leader Mitch McConnell wants another shot at repealing the Affordable Care Act, the law better known as Obamacare.

    "If we had the votes to completely start over, we’d do it," McConnell told Reuters in an interview Wednesday. "But that depends on what happens in a couple weeks ... we’re not satisfied with the way Obamacare is working."

    The GOP attempted to repeal and replace Obamacare in 2017 but were unable to do so despite holding majorities in each chamber of Congress. The party faced major roadblocks as Obamacare became more popular and each iteration of their replacement bill was greeted with distaste from the public. Their attempts eventually failed when the late Sen. John McCain signaled his vote against the repeal bill with his dramatic thumbs down.

    In the interview, McConnell called the failed repeal bid "the one disappointment of this Congress from a Republican point of view."

    Despite the swing and miss, the GOP and the Trump administration have been able to leave their stamp on the ACA. The Department of Health and Human Services has allowed states to apply for waivers to make major changes to their Medicaid programs that could result in fewer people being covered and slashed the funding for Obamacare outreach.

    For their part, congressional Republicans were able to repeal Obamacare's individual mandate— the requirement that all people must have health insurance or be faced with a penalty — as part of the GOP tax law.

    Senate Minority Leader Chuck Schumer quickly jumped on the comment, pointing to it as proof that the GOP wanted to gut various ACA protections, like safeguards for people with preexisting conditions.

    "Americans should make no mistake about it: if Republicans retain the Senate they will do everything they can to take away families’ health care and raise their costs," Schumer said in a statement. "Whether it be eliminating protections for pre-existing conditions, repealing the health care law, or cutting Medicare and Medicaid. Americans should take Senator McConnell at his word."

    Democrats have hammered Republicans in the run up to the midterm elections, attacking their votes on Obamacare repeal and replace bills that would have weakened preexisting condition protections.

    As it stands, McConnell may not get his chance at another repeal shot. While Republicans are forecast to hold the Senate, Democrats are heavily favorite to regain control of the House. 

    SEE ALSO: Mitch McConnell's call to cut Medicare, Social Security, and Medicaid also perfectly laid out why it won't happen anytime soon

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    • Support for President Barack Obama's signature domestic achievement — the Affordable Care Act, also known as Obamacare — is at record highs less than three weeks before the midterm elections. 
    • A majority of Americans (53%) and of likely voters (54%) approve of the healthcare law.
    • That is also significantly more than the 45% who approve of the Republican tax cuts passed last year.
    • The results could provide a boost to Democrats in November's elections as voters list healthcare as their top issue. 

    Support for President Barack Obama's signature domestic achievement — the Affordable Care Act, also known as Obamacare — is at record highs less than three weeks before the midterm elections, according to a new Fox News poll

    A majority of Americans (53%) and of likely voters (54%) approve of the healthcare law, significantly more than the 45% who approve of the Republican tax cuts passed last year.

    The polling represents a huge shift from just after the 2016 election, when approval for Obamacare hovered in the low 40s. It marks the culmination of two years of increasing approval of the law and the highest approval rating among registered voters polled by Fox since March 2015. 

    And last year's Republican effort to repeal the healthcare law was deeply unpopular. The American Health Care Act, which Republicans failed to pass the Senate. One poll found approval for the repeal law at 17%, while others found that as little as 8% of Americans supported the passage of the new law. A study found that the Republican effort — the attempted fulfillment of a key campaign promise — was the most unpopular bill in three decades

    Former President Barack Obama joked at a gathering last year that his signature domestic achievement was more popular than his successor, who had the lowest approval ratings of any president in modern history during hist first 100 days in office. 

    But on Wednesday, Senate Majority Leader Mitch McConnell insisted that Republican lawmakers would resume their efforts to repeal and replace Obamacare following November's midterm elections, calling the party's failure to do so last year "the one disappointment of this Congress from a Republican point of view."

    This year, voters have consistently listed healthcare among their top concerns. And Democrats are leveraging their upper hand on the issue to rally around a more radical shift in policy, namely single-payer healthcare, or "Medicare for All." 

    SEE ALSO: Democrats are embracing a radical change to US healthcare, and it could be the defining political fight for years to come

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    • Healthcare is emerging as one of the dominant issues in the 2018 midterm elections.
    • In particular, protections for people with preexisting conditions has become a key point of debate between Democrats and Republicans.
    • Democrats argue the GOP's attempts to repeal Obamacare would have undermined preexisting condition protections.
    • Republicans say they want to protect preexisting conditions while providing more choices for consumers.
    • Complicating the matter is a pending lawsuit against the ACA brought by 20 Republican state attorneys general.
    • Polls show that voters trust Democrats more on the issue.

    Healthcare is at or near the top of many Americans' lists of the most important issues in the 2018 midterm elections. 

    And the healthcare fight between the two parties seems to be coming down to one issue in particular: protections for people with preexisting conditions.

    Democrats are hammering their GOP opponents, arguing the Republican's repeated attempts to repeal the Affordable Care Act would have undermined protections for sicker Americans. The GOP argues that preexisting condition protections have always been a part of their healthcare platform. 

    President Donald Trump last week pledged that all Republicans believe — or would believe — in protecting people with preexisting conditions.

    "All Republicans support people with pre-existing conditions, and if they don’t, they will after I speak to them," Trump tweeted Thursday. "I am in total support."

    Here's what the preexisting condition fight is about

    Prior to the Affordable Care Act becoming law, insurers were able to deny people coverage due to a preexisting condition in many states. And in most states, even if insurers did offer plans to sick people, the companies could drive up premiums for people with preexisting conditions.

    The ACA's preexisting condition protections mostly helped people in the individual health insurance market — Americans who did not receive coverage from a job or a government program like Medicaid.

    The ACA created two major preexisting condition protections that were created under the ACA:

    1. Guaranteed issue: This provision made it so insurers were compelled to offer insurance to people with preexisting conditions.
    2. Community rating: This prevents insurers from charging people with preexisting conditions much higher rates than healthy people and pricing those people out of the market.

    While Republicans called for the complete repeal of Obamacare, many eventually recognized the popularity of the preexisting condition protections.

    The GOP adopted guaranteed issue as part of their policy, but community rating got a bit trickier in the rollout of the American Health Care Act — the House GOP's proposed ACA replacement:

    • Under the AHCA, states could apply for waivers that would weaken the community rating provision and allow insurers to charge based on health status — such as a preexisting condition — if a person did not maintain continuous insurance coverage.
    • States that received waivers could apply for funding to help alleviate the increased costs for people with preexisting conditions.
    • But many health policy experts viewed the amount of funding set out under the AHCA as inadequate. They warned that increased cost to sick Americans would result in many people with preexisting conditions being priced out of the market altogether.
    • According to a study by the Kaiser Family Foundation, a nonpartisan health policy think tank, the AHCA could have left as many as 6 million people with preexisting conditions without coverage. 

    Democrats argued the inclusion of the waivers showed the GOP would unnecessarily weaken protections for people with preexisting conditions, while Republicans said the law was designed to protect sick Americans while also driving down costs for healthier people in the Obamacare marketplaces.

    The looming lawsuit

    Clouding the midterm fight is a pending lawsuit brought by the Texas attorney general that could fully undo Obamacare's preexisting conditions protections.

    The Texas attorney general and 19 other Republican state attorneys general are arguing in federal court that since the GOP's tax law effectively repealed Obamacare's mandate that all people buy insurance, it is now unconstitutional. The AGs further argue that if the mandate is unconstitutional then all of Obamacare — including the popular protections — are also unlawful.

    The lawsuit has puts many Republican candidates in a bind as their states actively attempt to repeal the preexisting conditions in court while they try to convince voters of their desire to uphold those same protections.

    Screen Shot 2018 10 22 at 9.54.39 AM

    Two GOP senate candidates — Josh Hawley in Missouri and Patrick Morrisey in West Virginia — are the attorneys general in their states and are signed onto the lawsuit. Democrats Claire McCaskill and Joe Manchin — the incumbents in Missouri and West Virginia, respectively — have hammered their counterparts on the issue and it could help them hold their seats in otherwise red states.

    Manchin even dramatically shot a copy of the lawsuit with a gun in a eye-catching campaign ad released in September.

    Republicans scramble to win over voters

    According to a poll from the Kaiser Family Foundation released Friday, 58% of Americans say they more trust Democrats to continue preexisting condition protections, while just 26% of people say they more trust Republicans. Other polls have shown a similar trend.

    Given the discrepancy, Democrats are leaning into the issue:

    • 54.5% of all Democratic ads feature healthcare as the main issue, according to the Wesleyan Media Project.
    • Democratic leaders Chuck Schumer and Nancy Pelosi doubled down on the party's healthcare message in a joint statement Saturday. "Democrats are focused like a laser on health care and will not be diverted," the top Democrats said.

    But amid the flood of healthcare ads from Democrats, the GOP has attempted to fight back. Many candidates are pointing to their personal experiences with family members that have a preexisting condition and leaning on the AHCA's guaranteed-issue provision as proof that the party wants to provide coverage for people with preexisting conditions — while also providing choice.

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