http://www.politico.com/tipsheets/politico-pulse/2017/04/whats-in-the-gops-latest-deal-to-repeal-obamacare-219988

It’s here: Republicans’ latest Obamacare repeal-and-replace proposal dropped last night, as top House conservatives and a prominent moderate try to jump-start the stalled American Health Care Act.

WHAT’S IN REPUBLICANS’ LATEST DEAL — The eight-page amendment to the AHCA, which was hammered out by House Freedom Caucus Chairman Mark Meadows and Tuesday Group Co-Chair Tom MacArthur and scooped by POLITICO on Tuesday night, would allow states to opt out of Obamacare’s regulations on essential health benefits, community rating requirements and how much older Americans are charged for coverage.

It also would permit states to reject the continuous coverage provision that Republicans have proposed in their replacement bill. See the legislative text.

House Republicans exempted themselves from the proposal, Vox’s Sarah Kliff flagged first.

WHAT STATES WOULD NEED TO DO TO OPT OUT — Frankly, not that much. The amendment says that states would need to propose at least one of the following five to receive a waiver from HHS:

1) Reduce average premiums for coverage
2) Increase enrollment
3) Stabilize the market
4) Stabilize premiums for individuals with pre-existing conditions
5) Increase the choice of health plans

Based on the waiver, states also would have to set up a high-risk pool, presumably to push back on expected criticisms that the GOP plan would harm the sickest patients.

THE PRACTICAL IMPLICATIONS — The amendment dismantles major elements of the ACA that Republicans’ previous proposal would’ve kept, which had been a sticking point for wary conservatives. But cutting those protections means that even more Americans stand to lose coverage, which was already a no-go for many moderates.

Notably, the Congressional Budget Office projected last month that Republicans’ bill would result in 24 million fewer Americans having coverage in a decade. That number would likely increase under this amendment, a former CBO analyst told PULSE.

Expect quick reaction on the proposal: Both the Tuesday Group and the Freedom Caucus have meetings with their members today. But ahead of that …

http://www.politico.com/story/2017/04/27/senate-republicans-obamacare-repeal-237656

The House may finally be on its way to scrapping Obamacare, but don’t expect the Senate to go along: Any plan sent over will undergo major surgery — and survival is far from assured.

The hurdles in the upper chamber were on vivid display Wednesday as House Republicans celebrated their breakthrough on the stalled repeal effort. The compromise cut with House Freedom Caucus members won over the right flank, but the changes will almost surely make it harder to pick up votes in the more moderate-minded Senate.

Not to mention that some Senate conservatives still seem opposed to the emerging House deal.

“The Freedom Caucus has done a good job of trying to make the bill less bad,” Sen. Rand Paul (R-Ky.), one of the lead Senate agitators against the House health care push, said Wednesday. “For me, it’s a big stumbling block still that there’s taxpayer money that’s being given to insurance companies, and I am just not in favor of taxpayer money going to insurance companies.”

Phil Novack, a spokesman for Sen. Ted Cruz , also indicated that the conservative Texas firebrand isn’t sold, saying “significant work remains” in the Senate, “specifically to address Obamacare’s insurance mandates and enact major patient-centered reforms that will further reduce the cost of health care.”

Sources say it may take more than a month for any House health care bill to run through the traps in the Senate, including internal party discussions and an analysis of how the measure would affect the deficit and insurance rolls. No committee hearings are planned because Republicans don’t want to give Democrats a public forum to bash an effort they are not involved in. And similar to the Senate’s dim view of the House’s proposal, the lower chamber may not ultimately be able to pass whatever the Senate is able to produce on Obamacare.

Plus, a procedural rift is beginning to emerge within the GOP, with several Republicans questioning whether reconciliation — the fast-track legislative process that circumvents a filibuster, and thus the need for Democratic support — is even the best avenue for health care overhaul efforts.

Few Senate Republicans are currently engaged in the health care efforts. Several GOP senators declined Wednesday to wade in to the specifics of the revised plan drafted by Rep. Tom MacArthur (R-N.J.) and Freedom Caucus Chairman Mark Meadows (R-N.C.), taking pains to note that senators will probably have to rewrite it anyway.

“It isn’t discussed a lot over here,” said Sen. Chuck Grassley (R-Iowa). “Except for the hard work of [Susan] Collins and [Bill] Cassidy, there’s hardly anything being done.”

Senate Majority Whip John Cornyn (R-Texas), the party’s chief vote counter, also downplayed any notion that the new House version of an Obamacare replacement will sail through the Senate intact.

“Once they pass a bill, my assumption is, the Senate’s going to take a look at it but not necessarily be rubber-stamping what they’re proposing,” Cornyn said. “So I would anticipate that we’ll do what we used to do all the time which is, the House will pass a bill, we’ll pass a bill and then we’ll reconcile those in a conference committee.”

Weeks after the spectacular collapse of Obamacare repeal efforts last month, MacArthur and Meadows struck a deal with new language that would allow states to opt out of several key Obamacare provisions, such as its ban on charging sick people higher premiums and the so-called essential health benefits mandate that requires insurers to provide a set of minimum benefits.

The new language was enough to earn the formal endorsement of the Freedom Caucus, but House moderates who were opposed to the previous plan remain wary of backing a proposal that could cause constituents with pre-existing conditions to lose affordable health care coverage. In fact, the new plan may be having the reverse effect on some centrists: Rep. Mike Coffman (R-Colo.) had supported the initial Obamacare replacement but now says he’s a “maybe.”

Influential Senate Republicans also raised doubts about whether the new House proposal is workable.

http://www.realclearhealth.com/articles/2017/04/26/5_things_to_know_about_health_that_could_shut_down_the_government_110565.html?utm_source=RC+Health+Morning+Scan&utm_campaign=5d3df6bbc3-EMAIL_CAMPAIGN_2017_04_26&utm_medium=email&utm_term=0_b4baf6b587-5d3df6bbc3-84752421

Congress must pass a bill this week to keep most of the government running beyond Friday, when a government spending bill runs out. It won’t be easy.

The debate over a new spending bill focuses on an esoteric issue affecting the Affordable Care Act.

The question is whether Congress will pass — and President Donald Trump will sign — a bill that also funds subsidies for lower-income people who purchase health insurance under the law. These “cost-sharing reductions” (CSR) have become a major bargaining point in the negotiations between Republicans and Democrats, because the spending bill will require at least some Democratic votes to pass.

Here are five things to know about these cost-sharing subsidies:

How are these subsidies different from the help people get to purchase insurance?

There are two types of financial aid for people who buy insurance from an ACA exchange. People with incomes up to four times the poverty line, or $81,680 for a family of three, are eligible for tax credits to help pay their premiums.

In addition to that help, people with incomes up to two-and-a-half times the poverty line, or $51,050 for a family of three, get additional subsidies to help pay their out-of-pocket costs, including deductibles and copayments for care, as long as they purchase a silver-level plan. Insurance companies are required in their contracts with the government to provide these cost-sharing reductions to eligible people, then get reimbursed by the government.

Why are cost-sharing reductions suddenly front and center?

The fight dates to 2014, when Republicans in the House of Representatives filed suit against the Obama administration, charging that Congress had not specifically appropriated money for the cost-sharing subsidies and therefore the administration was providing the funding illegally.

A year ago, a federal district court judge ruled that the House was correct and ordered the payments stopped. However, she put that ruling on hold while the Obama administration appealed. That’s where things stood when Trump was inaugurated.

If the Trump administration drops the appeal, the funding would cease. However, Congress could also opt to approve funding the payments, which is what Democrats are pushing in the spending bill.

What would happen if these subsidies are stopped?

http://www.politico.com/story/2017/04/24/obamacare-repeal-consumer-protections-237541

While hardline House conservatives are falling in line behind the latest Republican Obamacare repeal bill, there’s ominous silence from most moderates whose support is also essential to getting the measure passed in the House.

The latest version would allow states to opt out of several key Obamacare protections, allowing insurers to charge older and sicker people more than younger and healthier people, according to a summary obtained by POLITICO. So far, none of the moderates who opposed an earlier repeal bill have publicly committed to supporting the latest version.

“This amendment doesn’t do anything to change my position on the health care bill,” said Rep. Charlie Dent (R-Pa.), who co-chairs the centrist Tuesday Group. “This amendment seems too much about meeting an artificial 100-day timeline,” he added, referring to President Donald Trump’s upcoming milestone date.

A proposal from Tom MacArthur (R-N.J.), and negotiated with the leader of the Freedom Caucus, would allow states to decline to require insurers to offer a minimum set of benefits and provisions allowing health plans to charge people more based on their age and health status. States can also opt out of enforcing a 30 percent surcharge for people who don’t maintain insurance coverage, according to a brief update sent to Energy and Commerce members.

The legislative text had been expected over the weekend. But the House has no plans to take up a repeal measure this week, despite the White House’s urging last week to do so. Republicans are expected to remain focused on funding the government past a Friday deadline for a new spending bill, with Obamacare repeal discussions likely continuing in the background. Members of the Freedom Caucus are expected to review the legislation together on Tuesday or Wednesday.

So far, moderates have largely remained mum on the latest changes to the repeal bill. Several moderates who opposed the bill said Monday through spokespersons that they hadn’t yet seen the legislative text.

“That hurts any timeline of [a vote] this week or next week,” said an aide to one lawmaker.

MacArthur is one of three co-chairmen of the Tuesday Group. At least some of the group of moderate Republicans would have to support the repeal bill if it has any chance of getting through the House.

“It’s our party, frankly, that has to get together and really realize sometimes you can’t vote for a perfect bill,” Rep. Adam Kinzinger (R-Ill.) said. “We need to work together, and that’s a learning process, I think, for Republicans in the House right now.”

MacArthur spent the congressional recess negotiating the deal directly with Freedom Caucus Chairman Mark Meadows (R-N.C.), leaving the Tuesday Group largely out of the loop. Indeed, some members had not seen any of the proposal’s details until drafts of the amendment were leaked out through the press.

States would be allowed to opt out of several of Obamacare’s consumer protections as long as they have set up high-risk pools, where consumers with costly medical expenditures would presumably be able to get coverage.

The waivers would strongly encourage people to maintain continuous coverage — even more than prior versions of the Republican repeal bill. In states that get a waiver, people who don’t stay insured can be charged more for insurance policies based on their health status.

The latest changes appear to preserve Obamacare’s requirement that insurers accept anyone regardless of their pre-existing conditions. But critics of the repeal bill argue that allowing insurers to charge sicker people more could in effect shut out those individuals because insurers will be able to charge whatever they want.

Under the Affordable Care Act, insurers had to charge sick and healthy consumers the same, with only a limited number of exceptions, including for age and tobacco use.

And with the House set to return to Washington on Tuesday, members of the Tuesday Group said there hasn’t been any coordination aimed at building support for the changes.

“Mr. LoBiondo has tweeted his thoughts thus far on the discussion — nothing additional to add at this point,” said an aide to Frank LoBiondo (R-N.J.), who tweeted Friday he’ll continue to oppose the bill. “I’m sure Politico will have any copy of the legislative text before members do.”