Tag Archives: ACA Repeal

Drugmakers Dramatically Boosted Lobbying Spending In Trump’s First Quarter

Posted on by • Posted in Uncategorized • Tagged , , , , , • Leave a comment

Drugmakers Dramatically Boosted Lobbying Spending In Trump’s First Quarter

Eight pharmaceutical companies more than doubled their lobbying spending in the first three months of 2017, when the Affordable Care Act was on the chopping block and high drug prices were clearly in the crosshairs of Congress and President Donald Trump.

Congressional records show those eight, including Celgene and Mylan, kicked in an extra $4.42 million versus that quarter last year. Industry giant Teva Pharmaceutical Industries spent $2.67 million, up 115 percent from a year ago as several companies embroiled in controversies raised their outlays significantly.

“It’s certainly a rare event” when lobbying dollars double, noted Timothy LaPira, an associate professor of political science at James Madison University. “These spikes are usually timed when Congress in particular is going to be really hammering home on a particular issue. Right now, that’s health care and taxes.”

Trump has come down hard on drugmakers, stating in a press conference before his inauguration that the industry is “getting away with murder.” He has promised to lower drug prices and increase competition with faster approvals and fewer regulations. Sens. Bernie Sanders (I-Vt.) and John McCain (R-Ariz.), and Rep. Elijah E. Cummings (D-Md.) have introduced bills to allow lower-cost drug imports from Canada or other countries.

Lobbyists weren’t expecting much by way of big policy changes during the comparatively sleepy end of the Obama administration this time last year, but with a surprise Trump administration and a Republican-controlled House and Senate, trade groups and companies are probably “going all in,” LaPira said.

Thirty-eight major drugmakers and trade groups spent a total of $50.9 million, up $10.1 million from the first quarter of last year, according to a Kaiser Health News analysis. They deployed 600 lobbyists in all.

PhRMA, the drug industry’s largest trade group, spent $7.98 million during the quarter —more than in any single quarter in almost a decade, congressional records show, topping even its quarterly lobbying ahead of the Affordable Care Act’s passage in 2010.

In their congressional disclosures, companies listed Medicare price negotiation, the American Health Care Act, drug importation and the orphan drug program as issues they were lobbying for or against. They do not have to disclose on which side of an issue they lobbied.

When Medicare prices are on the table, it should come as no surprise that pharmaceutical companies are interested in influencing congress.

“It’s quite literally hitting their bottom line,” LaPira said.

Drugmakers under fire more than doubled their lobbying dollars. Mylan spent $1.45 million during the quarter, up from $610,000 last year. The company’s CEO faced a congressional hearing in the fall when it raised the price of EpiPen to over $600.

Marathon Pharmaceuticals spent $230,000, which was $120,000 more than last year. Marathon was criticized in February after setting the price of Emflaza, a steroid to treat Duchenne muscular dystrophy, at $89,000 a year. That angered advocates, Congress and patients who had been importing the same drug for as little as $1,000 a year. Marathon has since sold the drug to another company, and the price may come down.

Teva and Shire also more than doubled their spending. Teva was accused as part of an alleged generic price-fixing scheme in December, and the Federal Trade Commission sued Shire because one of its recently acquired companies allegedly filed “sham” petitions with the Food and Drug Administration to stave off generics.

Companies that make drugs for rare diseases also more than doubled lobbying dollars as congressional leaders and the Government Accountability Office work to determine whether the Orphan Drug Act is being abused. Those firms include BioMarin, Celgene and Vertex Pharmaceuticals. Celgene, which makes a rare cancer drug, more than tripled its first quarter lobbying to more than $1 million.

Despite efforts to make good on campaign promises to repeal the Affordable Care Act, House Republicans canceled a floor vote on the American Health Care Act in March after multiple studies estimated that millions of people would lose coverage if it passed, and neither Democrats nor ultra-conservatives lined up in opposition to the bill’s provisions. Drug prices weren’t a key part of the package.

 

GOP to give Obamacare repeal another shot next week

Posted on by • Posted in Uncategorized • Tagged , , • Leave a comment

http://www.healthcarefinancenews.com/news/gop-give-obamacare-repeal-another-shot-next-week

Image result for aca repeal

The Republicans have a new plan to repeal and replace the Affordable Care Act, according to reports.

The new bill is expected to be out by the weekend and to get a vote by the mid-week in time for the president’s first 100 days, according to Politico. Sources told Politico they believe they are close to having the votes necessary to pass the bill.

House Speaker Paul Ryan pulled the previous bill, the American Health Care Act, when it became clear there were not enough votes for it to pass because of opposition from members of the conservative Freedom Caucus.

On April 13, Republican Representatives Tom MacArthur, a Republican from New Jersey, and Mark Meadows, who heads the Freedom Caucus seemed to come to a compromise on an amendment that gives states more flexibility while preserving consumer protections to get and retain health insurance.

The MacArthur Amendment to the American Health Care Act would reinstate essential health benefits as the federal standard, but would allow states to apply for a waiver for these essential health benefits as a way to reduce premium costs.

State waivers could also be applied for community rating rules that prevent insurers from varying premiums within a geographic area, except for factors of gender, health status and age. The later would have the exception of the 5:1 age ratio for older Americans.

Under the amendment, health status is also up for an exception in states that establish a high-risk pool or are participating in a federal high-risk pool.

It would prohibit denial of coverage due to preexisting medical conditions, guarantee coverage and renewal of coverage, and allow dependents to stay on their parents’ plans up until the age of 26 years old.

In mid-April, House Speaker Paul Ryan unveiled an amendment to the American Health Care Act that would create a federal risk sharing program for insurers.

Before the break, a House Rules Committee approved a mark-up of the amendment.

Ryan gave no cost to the amendment sponsored by conservative Reps. Gary Palmer of Alabama and David Schweikert of Arizona. Palmer said the Palmer-Schweikert proposal is modeled after what is being done in Maine. The risk-sharing program would be a federal program for three years and then turned over to the states, Palmer said.

In 2011, Maine overhauled its system, creating what is called an invisible high-risk pool for individuals with pre-existing conditions. The invisible high-risk pool was made of up individuals who had certain conditions that would have normally placed them in a regular high-risk pool.

However, these individuals did not know they were in the invisible high-risk pool and were not charged higher premiums. The invisible high-risk pool operated behind the scenes as the Maine Guaranteed Access Reinsurance Association.

 

Revised ACA Repeal-and-Replace Bill Likely to Increase the Uninsured Rate and Health Insurance Costs for Many

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , , • Leave a comment

http://www.commonwealthfund.org/publications/blog/2017/apr/amendment-aca-repeal-and-replace-bill

News outlets report that House Republicans are close to agreeing on an amended version of the American Health Care Act (AHCA), their proposed repeal and replacement of the Affordable Care Act (ACA). The all-important legislative language for the revised bill is not yet available, nor are Congressional Budget Office (CBO) projections of its effects on coverage and the budget, so any analyses are necessarily tentative.

Nevertheless, the summaries leaked to the media offer insight on the amended bill. If accurate, those summaries suggest that the revised AHCA will significantly increase the numbers of uninsured Americans, raise the cost of insurance for many of the nation’s most vulnerable citizens, and, as originally proposed in the AHCA, cut and reconfigure the Medicaid program. The new amendment specifically allows states to weaken consumer protections by, for example, permitting insurers to charge people with preexisting conditions higher premiums.

What the Amendment Leaves in Place

The amended proposed bill does little to change many provisions of the original AHCA including:

The CBO estimated in March that the combined effects of these provisions would increase the number of people without health insurance by 24 million by 2026. Older Americans would be particularly hard hit by the bill, experiencing much higher premiums relative to the ACA and the greatest coverage losses.

What the Amendment Changes

The amendment offers states the option to apply for waivers to reduce ACA consumer protections that have enabled people with health problems to buy private health insurance. States could waive the ban on charging people with preexisting conditions higher premiums, as long as states set up high-risk pools for people with conditions like cancer or heart disease who could no longer afford coverage. States could also change the ACA’s required minimum package of health benefits for health plans sold in the individual and small-group markets.

Despite the fact the federal ban on preexisting condition exclusions would remain under the AHCA, as Tim Jost points out, insurers could reach the same end by not covering services like chemotherapy that sick people need, or by charging very high premiums for individuals with expensive, preexisting problems. In addition, waiving the ACA’s essential benefit requirement could weaken other consumer protections like bans on lifetime and annual benefit limits and caps on out-of-pocket costs.

While states that allowed higher premiums for people with health problems would be required to use a high-risk pool under the amendment, prior research has found that such pools operated by states before the ACA were expensive both for states and for people enrolled in them, and covered only a small fraction of the individuals who would have benefited. An amendment proposed earlier in the month would provide federal funds for a so-called “invisible risk-sharing” program, a hybrid between a high-risk pool and reinsurance for high claims costs, but the allocated funding would likely need to be much higher to have an impact on costs.

The number of states that would apply for these waivers is unknown, but it seems reasonable to expect that many states with governors and legislatures that have opposed the ACA would do so. For a substantial part of the country, therefore, the amendment could seriously undermine the ACA’s protections for people with preexisting health conditions.

 

White House, Republican leadership downplay chances of quick healthcare deal

Posted on by • Posted in Uncategorized • Tagged , , • Leave a comment

‘Iranians are no threat to Americans’: Ann Coulter blasts Trump focus on Iran instead of ‘this hemisphere’

Image result for aca repeal

White House officials and Republican aides worked to downplay expectations of an imminent vote on Obamacare reform legislation Thursday amid widespread speculation that a healthcare deal was in the offing.

While both the White House and GOP aides confirmed that healthcare negotiations have continued throughout the congressional recess, both sides stressed that a compromise bill may not be ready for a vote by next week, when lawmakers return from their two-week break.

“Congress needs to act quickly on a solution for the American people. Our administration is engaged in those conversations and we are making progress,” a White House official told the Washington Examiner. “But there is not a set deadline to complete it.”

A senior Republican aide told the Examiner that discussions about how to unite members behind an Obamacare reform bill had yielded “no legislative text.”

And Trump himself expressed uncertainty that a new version of the healthcare bill would be ready by next week, although he predicted it could be ready “shortly thereafter.”

“We’re doing very well on healthcare,” Trump said. “We’ll see what happens.”

Premium Increases for Pre-Existing Conditions Under Latest ACA Repeal Plan, by State

Posted on by • Posted in Uncategorized • Tagged , , , , , • Leave a comment

https://www.americanprogress.org/issues/healthcare/news/2017/04/21/431019/premium-increases-pre-existing-conditions-latest-aca-repeal-plan-state/

Hundreds of people march through downtown Los Angeles protesting President Donald Trump's plan to dismantle the Affordable Care Act, March 23, 2017.

Repealing protections for people with pre-existing health conditions could be on Congress’ agenda as early as next week. Facing pressure from the Trump administration, Congress may be ready once again to try to repeal the Affordable Care Act, or ACA. This time around, Congress is discussing including an amendment that would allow insurance companies in the individual market to charge higher rates to consumers based on health status.

Under the deal that was leaked, states would be able to waive protections for pre-existing conditions for any reason, as long as they set up a high-risk pool or participated in a federal risk-sharing program. Before the ACA, all but seven states allowed insurance companies to charge higher premiums to people with pre-existing conditions.

Without pre-existing condition protections, health care would become prohibitively expensive for those who need it most. People with asthma, a relatively minor chronic condition, would face a markup of about $4,000 for coverage, while those with severe illnesses such as heart trouble or cancer would face premiums tens of thousands of dollars above standard rates.

The cost of care varies by state, and health insurance costs do too. The Center for American Progress has estimated the premium surcharges that consumers in each state—and the District of Columbia—would face for five conditions under the new congressional Republican proposal: breast cancer; pregnancy; major depression; diabetes; and asthma. We have also accounted for the federal risk-sharing program that Republicans in Congress have put forward as a means of limiting premium increases. The numbers in the table are the average increases that people currently experiencing the listed conditions would pay on top of the standard rate for health coverage, including the new risk-sharing program.

However, as evidence from before the passage of the ACA shows, insurance companies would also set rates based on previous ailments. More than 130 million nonelderly Americans have pre-existing conditions, and the return of rating on health status would subject them to thousands of dollars of extra expenses for individual market coverage.

Seven states had pre-existing condition protections in place before the ACA: Maine; Massachusetts; New Jersey; New York; Oregon; Vermont; and Washington. We assume that these states would not seek an AHCA waiver to allow rating based on health status and therefore did not calculate health-based surcharges for these states.

 

Trump must decide whether to support or undermine Obamacare

Posted on by • Posted in Uncategorized • Tagged , , , , , • Leave a comment

https://www.washingtonpost.com/powerpost/trump-must-decide-whether-to-support-or-undermine-obamacare/2017/04/19/a52193d6-2502-11e7-bb9d-8cd6118e1409_story.html?_hsenc=p2ANqtz–qRGfjVng2ifif04sBWoB8BnXqWE4AiaOdpPtzmNgoRlaZrrLLv_6KRsxf7m-me-xNmGjvXicczyd7NO4Wdur8XJpBzQ&_hsmi=50970117&utm_campaign=KHN%3A%20First%20Edition&utm_content=50970117&utm_medium=email&utm_source=hs_email&utm_term=.4095c5893438

Image result for ACA

President Trump is pressuring Congress to sink parts of the Affordable Care Act. But now that the first attempt at a GOP health-care overhaul has failed, he must decide whether to throw the law a line.

The White House and Republican lawmakers are facing key decisions that could either improve the insurance marketplaces established by the ACA next year or prompt insurers to further hike rates or withdraw from those marketplaces entirely. Republicans had hoped to protect those with marketplace coverage while lawmakers replaced Obamacare.

But with that effort hitting a wall, Trump and his health-care decision-makers are in a bind: They can either let the current system fail and risk raising the ire of 11 million Americans who use the marketplaces, or help stabilize Obamacare and potentially make it harder for Republicans in Congress to abandon the law itself.

“It’s an awkward political environment, there’s no question about it,” said Lanhee Chen, a health-policy expert and former adviser to 2012 presidential candidate Mitt Romney.

Republican objections to the ACA naturally lead them away from assisting it, but the party now bears some responsibility for what happens to it, Chen added.

“The reality of this is Republicans will face some political repercussions for what happens to Obamacare,” he said.

Trump and other Republicans have long predicted a so-called death spiral for the state-based marketplaces set up under President Obama’s signature domestic achievement. Trump has often tweeted and said on the campaign trail that the law will “die of its own weight.” He shrugged off the recent failure of the GOP health-care bill by saying the law is “exploding” anyway.

“The best thing we can do, politically speaking, is let Obamacare explode,” Trump said in the Oval Office last month. “It’s exploding right now.”

The dire predictions have partially come true: Although some state marketplaces offered multiple plan options and only modest premium raises last year, many others provided only one plan choice and double-digit premium hikes. Next year’s outlook is still unclear, but it’s unlikely the marketplaces will suddenly attract a better mix of healthy enrollees to help lower costs.

If the marketplaces further deteriorate, Republicans may take the fall, surveys show. A recent Kaiser Family Foundation poll found that a majority of Americans will now blame Republicans, not Democrats, for marketplace problems, because the GOP spent the past seven years promising to fix and replace the system.

That reality is forcing Republicans, including Trump, to seriously consider a half-dozen actions that could help improve — or at least sustain — the marketplaces where Americans without employer-sponsored plans buy coverage.

“Looking at next year, if we imagine that the marketplace right now is, say, a C-minus, there are several things that need to be done to just preserve it at its C-minus level,” said Mike Adelberg, who under Obama directed the Center for Consumer Information and Insurance Oversight established at the Department of Health and Human Services.

There is a list of actions the administration must decide whether to take to keep the marketplaces humming, most of them through regulatory actions at the Health and Human Services Department or through the Internal Revenue Service.

The actions center on three programs: cost-sharing reductions, reinsurance and risk corridors. Cost-sharing refers to government subsidies to low-income Americans to help them pay for insurance. Trump threatened recently to let such subsidies lapse, but Democrats say they will shut down the government as part of the spending negotiations next week if the president follows through.

Administration officials and lawmakers are still deciding how to handle the issue. A White House spokesman said only that “no decisions have been made at this time.”

Reinsurance and risk corridors are two programs set up under the ACA to redistribute funds from insurers with healthier enrollees to insurers with sicker, more expensive customers.

The marketplaces could also be hurt or helped depending on whether the IRS enforces the ACA’s individual mandate to buy coverage and whether the administration enforces new, tighter rules around enrollment.

Medical Loss Ratio: Updates and Impact

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

http://bhmpc.com/2017/04/medical-loss-ratio-updates-impact/

Medical Loss RatioMedical Loss Ratio

Healthcare spending is on the rise. The federal government has begun several initiatives to control costs, increase efficiency, and increase quality. Revisiting one of the Affordable Care Act’s (ACA) metrics, Medical Loss Ratio.

As we all know, healthcare costs are skyrocketing. The US government is trying to look at healthcare spending from all angles in an effort to control costs while increasing quality. It has become a balancing act. The evolution of the American Health Care Act (AHCA) leaves open the possibilities of re-imagining a number of provisions of the ACA increasing the effectiveness of reducing costs and increasing quality. One provisios of particular interest is the Medical Loss Ratio which was supposedly designed to add efficiency, reduce waste, and control administrative costs for a currently broken healthcare system.

Medical Loss Ratio  (MLR) Rule

MLR existed long before ACA; was used to evaluate performance of managed care companies. ACA created a federal standard and modified the calculation.

The Affordable Care Act requires health insurance companies to disclose how much they spend on health care and how much they spend on administrative costs, such as salaries and marketing. If an insurance company spends less than 80% (85% in the large group market) of premium on medical care and efforts to improve the quality of care, they must refund the portion of premium that exceeded this limit. This rule is commonly known as the 80/20 rule or the Medical Loss Ratio (MLR) rule.

Modern Healthcare reports, House conservatives and outside experts doubt HHS Secretary Tom Price has legal authority to substantially revise the Affordable Care Act’s key insurance market regulations and other provisions by issuing new rules and guidance. Price could also withdraw the rule released last year that overhauled regulation of Medicaid managed care programs. If Price tries to rescind that rule, network adequacy provisions, a medical loss ratio mandate for managed care plans, and managed long-term services and supports policies would all be eliminated.

Forbes reports this week, “The Trump administration can start by modifying Obamacare’s “medical loss ratio” rules, which dictate how insurers must spend the money they collect in premiums. If or when the MLR requirement ends, maybe the MLR’s impact and importance remains a visible measuring stick of performance.

CNBC used MLR in this story, yesterday. “UnitedHealthcare reported medical care ratio, or the amount it spends on medical claims compared with the insurance premiums that it brings in, of 82.4 percent, an increase of 70 basis point. “We see a positive set up for peers based on a read through of the company’s better-than-expected medical loss ratio and strong Medicaid performance,” Piper Jaffray analyst Sarah James said.”

Trump Group’s Ads Bolstering GOP Obamacare Repeal Drive

Posted on by • Posted in Uncategorized • Tagged , , • Leave a comment

https://www.nytimes.com/aponline/2017/04/17/us/politics/ap-us-health-overhaul-ads.html?_r=0

Related image

A pro-Trump group is airing ads in a dozen Republican-held House districts aimed at drumming up support for the White House’s wounded drive to repeal President Barack Obama’s health care law.

The $3 million campaign comes during a two-week congressional recess in which GOP lawmakers’ town hall meetings have been rocked by liberal supporters of Obama’s 2010 statute. Underscoring the challenges Republicans face, one poll showed Monday that the public trusts Democrats over the GOP on health care by their biggest margin in nearly a decade.

Leaders averted a planned House vote last month on a bill replacing much of Obama’s law with a GOP alternative because Republican divisions would have ensured its defeat. White House officials complained at the time that while conservative outside groups opposing the bill had pressured lawmakers, there was insufficient lobbying and advertising by supportive organizations.

Talks among White House officials and GOP lawmakers have continued during the break, but there have been no tangible signs that they’ve found a way to reverse what has been a damaging defeat for President Donald Trump and congressional leaders.

The TV and internet ads by America First Policies are running in districts from Arizona to Pennsylvania, the group said Monday. Some are represented by lawmakers who backed the GOP legislation, others opposed it and others hadn’t taken clear public positions.

One ad aimed at Rep. Gary Palmer, R-Ala., urges people to thank him “for standing with President Trump to repeal Obamacare now.” Palmer said after the House vote was canceled that he backed the decision to pull the bill so work on the legislation could continue.

America First Policies is run by former Trump White House and campaign staffers including Katie Walsh, who left her job as White House deputy chief of staff shortly after the leaders’ retreat from the House vote.

A poll by the nonpartisan Pew Research Center showed that by 54 percent to 35 percent, more people think Democrats do a better job than Republicans handling health care. Though the public has usually given Democrats an advantage on the issue in Pew polls, the two parties were ranked about evenly as recently as 2013.

Obamacare’s Insurers Struggle for Stability Amid Trump Threats

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , • Leave a comment

https://www.bloomberg.com/politics/articles/2017-04-17/obamacare-s-insurers-struggle-for-stability-amid-trump-threats

Image result for Obamacare's Insurers Struggle for Stability Amid Trump Threats

Obamacare is stuck in limbo, and insurers and state regulators are struggling to set their plans for what’s increasingly shaping up as a chaotic year for the health-care program.

After the failure of Republicans’ first attempt to repeal and replace the Affordable Care Act and President Donald Trump’s subsequent threats to let the program “explode,” more health insurers are threatening to pull out next year, while others may sharply raise the premiums they charge. They’ll start to declare in the next few weeks whether they’re in or out.

Marguerite Salazar, Colorado’s insurance regulator, said that her state’s carriers, which include Anthem Inc. and Cigna Corp., haven’t said they’re leaving, though they don’t want to commit either.

“That’s my biggest fear, is that we would lose carriers in the individual market,” Salazar said. “We don’t want to set up an environment that would tell them, well, maybe we don’t need to be here.”

In Washington, Insurance Commissioner Mike Kreidler pushed back by a month the date when insurers have to say what they’ll offer. He’s urging them to stay and thinks most will, but “they’re not making commitments right now.”

“They’ve got those cards and they’re holding them close,” said Kreidler, a Democrat. “Right now, there’s so much uncertainty.” The fear is that they’ll follow the lead of Aetna Inc. and Wellmark Inc., which pulled out of Iowa’s Obamacare markets this month.

Trump’s Uncertainty

Much of the uncertainty is thanks to the Trump administration, which will play a key role in deciding whether the health law’s markets collapse or survive. Industry representatives — including company executives and insurance lobby CEO Marilyn Tavenner — are scheduled to meet Tuesday with Seema Verma, the head of the Centers for Medicare and Medicaid Services, the U.S. agency that oversees the law.

Trump’s latest threat has been to stop payments that subsidize co-pays and other upfront costs for lower-income people. Without them, insurers would likely boost their premiums or drop out entirely. The administration has refused to commit to keeping the payments going.

Health insurers see April 30 as a key deadline for a decision on the cost-sharing payments. They’ll start filing with some state regulators in May to say whether or not they’ll stay in the markets.

“Everybody is still in a wait-and-see mode,” said Kristine Grow, a spokeswoman for the industry group America’s Health Insurance Plans. AHIP and other industry groups are pushing the administration to commit to making the cost-sharing payments that Trump has threatened to halt. “Plans really need certainty,” she said.

 

The GOP’s problem on health reform is they’ve spent years hiding their real position

Posted on by • Posted in Uncategorized • Tagged , , , , • Leave a comment

http://www.vox.com/policy-and-politics/2017/4/17/15325366/gop-problem-on-health-reform

The most interesting policy argument in America right now is the debate between conservatives’ real position on health care and their fake position.

The fake, but popular, position goes something like this: Conservatives think everyone deserves affordable health insurance, but they disagree with Democrats about how to get everyone covered at the best price. This was the language that surrounded Paul Ryan and Donald Trump’s Obamacare alternative — an alternative that crashed and burned when it came clear that it would lead to more people with worse (or no) health insurance and higher medical bills.

Conservatives’ real, but unpopular, position on health care is quite different, and it explains their behavior much better. Their real position is that universal coverage is a philosophically unsound goal, and that blocking Democrats from creating a universal health care system is of overriding importance. To many conservatives, it is not the government’s role to make sure everyone who wants health insurance can get it, and it would be a massive step toward socialism if that changed.

This view provided the actual justification for Ryan and Trump’s Obamacare alternative — it’s why they designed a bill that led to more people with worse (or no) health insurance and higher medical bills, but that cut taxes for the rich and shrank the government’s role in providing health care.

There was, for decades, a logic to the GOP’s dual positions: the fake but popular position was used to pursue the ends of the real but unpopular position. But in the post-Obamacare world, the chasm that has opened between conservatives’ fake and real positions has become unmanageable, and how — or whether — conservatives resolve it has become perhaps the most interesting public policy question going today.

A real conservative health care debate worth hearing

On the latest episode of Peter Robinson’s Uncommon Knowledge, Avik Roy and John Podhoretz have perhaps the most honest and bracing discussion of this I’ve heard. Podhoretz, a columnist and editor with a deep pedigree in conservative politics, begins by arguing that the passage of Obamacare, and the debate over the American Health Care Act, shows a “Rubicon” has been crossed in American politics — there is now an “almost unspoken acceptance of the idea that there should be universal coverage for health care in the United States.”