http://www.politico.com/story/2017/04/obamacare-repeal-bill-gop-zombie-237215

Republicans in Congress for the first time are lowering expectations for how much of Obamacare they can repeal and how quickly they can do it.

As they meet constituents back home, GOP lawmakers seem trapped between the reality of their failed repeal effort and President Donald Trump’s renewed promises this week to finish off Obamacare before taking on tax reform. Vice President Mike Pence is also still trying to keep the repeal dream alive, working with conservatives on new tweaks to the stalled House bill. But even if the ultra-conservatives come on board, there’s no sign that the moderate Republicans needed to pass a bill are ready to sign on.

Those dynamics mean the Obamacare repeal effort that has helped define the Republican Party for seven years may live on in a sort of political purgatory — with no one willing to pull the plug even though there are few signs of life. The uncertainty created by that zombie state could compel health insurers to stop offering coverage in the exchanges next year, paralyze action on other legislative priorities on Capitol Hill and come back to haunt Republicans at the polls in 2018.

Lawmakers back in their districts during their first recess since the collapse of the House effort are downplaying the repeal agenda as if the rallying cry to eliminate the law “root and branch” has been pared down to some leaves. Some constituents are conveying their displeasure.

Joe Barton (R-Texas), a Freedom Caucus member, was confronted at a town hall meeting Tuesday by a self-described Republican who blasted the GOP for not repealing all of Obamacare on “Day One of the Trump administration.”

GOP wrestles with big question: What now?

Republicans at both ends of Pennsylvania Avenue are facing a big question this spring: What now?

As President Trump approaches his 100-day mark at the end of this month, congressional Republicans have few accomplishments to point to and are divided over how to proceed on his two biggest priorities: healthcare and tax reform.

Congress is at the start of a two-week recess, and lawmakers say they will listen to feedback from constituents as they mull the next legislative steps of 2017. The internal debate boils down to whether they should stick to their strategy of working strictly along party lines to pass big-ticket bills or try to find common ground with Democrats, perhaps on smaller proposals.

Republicans are divided over whether to take another shot at healthcare reform, which failed in the House last month, or move on to tax reform.

https://www.medpagetoday.com/Washington-Watch/repeal-and-replace/64426?xid=nl_mpt_DHE_2017-04-07&eun=g1061559d0r&pos=0

For years, Republicans vowed that if they ever got control of the White House and both houses of Congress, the Affordable Care Act would quickly end up in the trash heap. As of January 20, those pieces were firmly in place.

Yet nearly 3 months later, the GOP appears no closer to enacting a repeal-and-replace bill than they were when Barack Obama was sitting in the Oval Office.

House Republican leaders have been unable to forge a consensus among its conservative and moderate wings as to what should come after the ACA. One bill had to be pulled from a floor vote when it became clear that neither the GOP’s Freedom Caucus nor Democrats would support it. And, earlier this week, a push led by top administration officials to appease the Republican conservatives — by making certain ACA elements retained in the GOP plan optional for states — was quickly declared dead on arrival.

MedPage Today asked physicians and policy experts why President Obama’s signature legislation is so hard to kill and whether Republicans might give up trying.

“Advocacy against the AHCA [American Health Care Act, the GOP’s initial repeal-and-replace bill] was broad and intense, with health care and public health organizations repeatedly raising concerns about health insurance coverage, access, and costs, including proposed dramatic changes to Medicaid funding that would preferentially hurt low-income people (including children), and risks of coverage gaps for those with chronic and pre-existing conditions,” wrote Jan Carney, MD, MPH, associate dean for public health and professor of medicine at the University of Vermont in Burlington, Vt., in an email.

Carney underscored the importance of the Congressional Budget Office’s report projecting a dramatic increase in the number of uninsured Americans — 14 million more in 2018 and 24 million more in 2026.

She also highlighted an April 4 Kaiser Family Foundation poll, which found 75% of Americans felt that Congress should work on fixing the ACA instead of repealing it.

https://www.nytimes.com/aponline/2017/04/10/us/politics/ap-us-health-overhaul-shifting-focus.html

Move over, “Obamacare.” The health care debate has shifted to ideas from President Donald Trump and GOP lawmakers in Congress, and most people don’t like what they see.

With Republicans in command, their health care proposals as currently formulated have generated far more concern than enthusiasm.

Even among rank-and-file Republicans, there’s opposition to changes that would let insurers charge higher premiums to older adults, and many disapprove of cuts to Medicaid for low-income people, according to a recent poll by The Associated Press-NORC Center for Public Affairs Research. It also found more than half of Republicans at least somewhat worried about leaving more people uninsured, as the House plan is projected to do.

March polls by Fox News and Quinnipiac University showed overall margins of opposition to the GOP bill nearing or even exceeding those of the Obama-era Affordable Care Act, or ACA, at its lowest points — such as when the HealthCare.gov website went live in 2013 and promptly crashed.

“Republicans are taking ownership of the health care issue, and all the pleasure and pain of health reform,” said Drew Altman, president of the nonpartisan Kaiser Family Foundation, which tracks the health care system. “There has been a shift in focus from the ACA itself to the Republican plans, and who might lose benefits as a result.”

Highlighting the stakes, the uninsured rate among U.S. adults rose slightly in the first three months of this year, according to Monday’s update of a major ongoing survey. The Gallup-Healthways Well-Being Index found that 11.3 percent of adults were uninsured, an increase from 10.9 percent in the last two calendar quarters of 2016.

“Only time will tell” if the uptick means the U.S. is again losing ground on health insurance, said survey director Dan Witters.

“A lot of uncertainty has been introduced into the marketplace through efforts to repeal,” Witters added. “That will scare people off who have real reason to believe that the ACA won’t even exist in a year. Plus premiums are now realizing a big jump for the first time in the ACA era, so some folks may be priced out of the market even with income-based subsidies.”

Trump came into office with big, bold promises. In a Washington Post interview shortly before his inauguration he declared his goal was “insurance for everybody,” hand-in-hand with affordable coverage, “lower numbers, much lower deductibles.” Although Trump said he’d soon release a plan, none appeared.

Instead, after weeks of laboring behind closed doors, House Republican leaders rolled out a proposal March 6 that the president enthusiastically embraced. But all the efforts of the White House and congressional leadership haven’t convinced GOP lawmakers to pass it. Congress is on a two-week break with the bill in limbo.

Frustrated, Trump is seeing his promise slip away to quickly repeal “Obamacare” and replace it with something better. Instead he could get left as the caretaker of the ACA, a law he’s repeatedly called a “disaster” on account of rising premiums and insurer exits that diminish consumer choice in many communities.

Trump’s personal image has taken a blow, with the AP-NORC poll finding that he gets his worst rating on health care. About 6 in 10 people disapprove of how the president has handled the issue.

“It is a major failure that a high priority of President Trump and the congressional Republican leadership leads to no bill, and the bill as proposed becomes unpopular even among their own voters,” said Robert Blendon, a professor at the Harvard T.H. Chan School of Public Health, who follows opinion trends on health care. “It’s a real leadership crisis issue.”

Amid disapproval of the House GOP plan, some polls have shown improved ratings for the ACA. Gallup, for example, found “Obamacare” gained majority approval for the first time. But Republican voters remain overwhelmingly opposed to former President Barack Obama’s signature law and want it repealed.

Nonetheless, there’s recent evidence that Republicans differ among themselves about what “repeal” may mean.

A Quinnipiac poll last month found that 55 percent of Republicans said Trump and the Republican-led Congress should repeal “parts” of the ACA, while 42 percent said “all” of it should go. Only 2 percent of Republicans said the law should not be repealed.

Republican views compare with 50 percent of the general public who say parts of the ACA should be repealed, 20 percent who say all of it should be repealed, and 27 percent who say it should remain.

The divisions among rank-and-file Republicans appear to mirror those in the House, where disagreements among hardliners and moderates are keeping Speaker Paul Ryan, R-Wis., from taking the bill to the floor.

Tim Malloy, assistant director of the Quinnipiac poll, said, “You have to figure a lot of people who voted for Trump are on Obamacare.”