http://www.fiercehealthcare.com/hospitals/hospital-impact-no-consensus-sght-for-republican-aca-replacement?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTWpOa05HWTNOVEF5Tm1FMCIsInQiOiJEejZXRWZkc3NMU1hWNHR0U3dFUllRZyt1NFg3a1wvMWFyaUoyUHlGVWg3M2VETmFSeUc5K3ZUdWsyVlVUMkxieVVZVW5GZlgxbHN0WXBZelR6SGlQSWtJWkFtSjFaQjUyVFFhbEw4TkI1VW5ORDRHOHlKV3lRWFdSRU5HbWpab3UifQ%3D%3D

Two major proposals emerged last week to replace the Affordable Care Act that differ significantly in both content and potential impact.

Clearly, both of these proposals represent initial offerings that will be modified or even replaced by others as Republican lawmakers tackle the difficult task of fixing a flawed and controversial law. The ACA offers important protections yet requires modification into a sustainable model that supports both insurance providers and those most in need of healthcare services.

Clearly the work on replacing the ACA has just begun.

https://www.healthinsurance.org/blog/2017/01/20/obamacare-is-not-toast/

Republicans have the votes – and pressure from their base – to demolish many of the ACA’s gains. Here’s why they probably won’t.

GOP talk shifts from replacing ObamaCare to repairing it

Key Republican lawmakers are shifting their goal on ObamaCare from repealing and replacing the law to the more modest goal of repairing it.

It’s a striking change in rhetoric that speaks to the complexities Republicans face in getting rid of the Affordable Care Act. Many of the law’s provisions are popular, and some parts of the law that the GOP does want to repeal could have negative repercussions on the parts seen as working.

“I’m trying to be accurate on this that there are some of these provisions in the law that probably will stay, or we may modify them, but we’re going to fix things, we’re going to repair things,” House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), a key player on healthcare, told reporters Tuesday.

“There are things we can build on and repair, there are things we can completely repeal,” he said.

Senate Health Committee Chairman Lamar Alexander (R-Tenn.) is sounding a similar note. He notes that Republicans plan to use special budget rules known as reconciliation to prevent Democrats from filibustering a vote to repeal ObamaCare. The use of those rules won’t allow all of ObamaCare to be repealed.

“I think it is more accurate to say repair ObamaCare because, for example, in the reconciliation procedure that we have in the Senate, we can’t repeal all of ObamaCare,” Alexander said. “ObamaCare wasn’t passed by reconciliation, it can’t be repealed by reconciliation. So we can repair the individual market, which is a good place to start.”

Not everyone is on board with the new rhetoric.

Some Republicans say their party should be focused on repealing the law and replacing it, not repairing it.

“I’m hearing a lot of members say that they want ObamaCare-lite,” said Rep. Raúl Labrador (R-Idaho). “That’s not what we promised the American people.”

https://hbr.org/2017/02/u-s-health-care-reform-will-require-politicians-to-change-their-attitude

It is no secret that replacing the Affordable Care Act, popularly known as Obamacare or the ACA, is high on the agenda of the incoming Republican administration and Congress. Speaker Paul Ryan has said that the law has “failed.” In the campaign debates, Donald Trump said it was “destroying our country.” But even as the new administration has issued its initial executive orders, Republicans have yet to offer a true alternative plan, and the timing on replacement is still hazy.

Given that one party controls both the executive and legislative branches of government, one might be tempted to think that “renegotiate” may be the wrong word — that “fiat” may more appropriate. Not so fast. There are Republican governors who oppose the rollback of Medicaid expansion. Even within Congress there are differences over whether a repeal should take effect immediately or over time. Despite the demonization of the ACA on the campaign trail, there are elements of the law that are quite popular across the political spectrum. While the president has stated on the record that he wants health care for everyone, his nominee for secretary of health and human services refused to back that promise in confirmation hearings.

The policy and politics promise to be nettlesome at best, and many experts are weighing in. At the Program on Health Care Negotiation and Conflict Resolution, at the Harvard T.H. Chan School of Public Health, we look most closely at the leadership and negotiation issues, each of which offers opportunities as well as pitfalls that can be seen clearly even now.

Given the number of stakeholders and the diversity (and divergence) of their interests and points of leverage, “renegotiating” is exactly the right word. And there are few negotiations as complex as reforming the U.S. health care system. Certain changes can be forced into the system from on high, but the essential goodwill, commitment, and voter loyalty that political will is derived from cannot be commanded.

The promise of much better care at greatly reduced costs for citizens is simply a fantasy unless Congress is willing to increase subsidies for coverage. The budget hawks on Capitol Hill are not likely to go along with that. Or they could regulate prices, but that is also anathema to conservatives. Physicians and hospitals will come to the table wanting more now that they better understand the impact of the various components of the ACA. Insurers will remember that Congress funded just 12.6% of their claims under the “risk corridors” of the ACA and will want greater certainty regarding the risks they are undertaking. The public’s expectations are that the parts of the law they like will remain — including the expense-heavy coverage for preexisting conditions and elimination of lifetime benefit caps — while those they dislike, such as the employer and individual mandates that help mitigate risk and lower costs, will go away.

http://www.vox.com/policy-and-politics/2017/1/31/14455656/obamacare-trump-drug-prices

If Trump’s pharma comments are any clue, we have no idea what he wants on Obamacare

President Trump has apparently done some rethinking on his views of American drug pricing policy, offering confusing remarks that indicated he might not support Medicare negotiating drug prices.

“I’ll oppose anything that makes it harder for smaller, younger companies to take the risk of bringing their product to a vibrantly competitive market,” Trump said after meeting with pharmaceutical executives Tuesday. “That includes price-fixing by the biggest dog in the market, Medicare, which is what’s happening.”

This appears to contradict what he said a mere two weeks ago, at a press conference in Manhattan. “Pharma has a lot of lobbies, a lot of lobbyists, and a lot of power. And there’s very little bidding on drugs,” he said there. “We’re the largest buyer of drugs in the world, and yet we don’t bid properly.”

This back and forth on drug pricing is suggestive of what to expect from the president on the Affordable Care Act. There too, Trump has made big promises that most of his Republican colleagues on the Hill have not. The biggest one is that he will come up with a plan to cover everybody and do it at a lower cost than Obamacare.

In this drug pricing example, I see how Trump could break his promise to cover everyone. It boils down to three main reasons, all present in the drug pricing situation.

http://www.vox.com/the-big-idea/2017/2/1/14463904/obamacare-executive-power-trump-law

This month, Kellyanne Conway, senior adviser to President Donald Trump, was asked whether the administration would refuse to enforce the Affordable Care Act’s individual mandate — the requirement that people get health insurance or pay a penalty. “He may,” she said, instantly sending a shiver of fear down the spines of health reform’s supporters. Without the mandate, insurance markets in many states will teeter; some will probably collapse.

Would it be legal for Trump to decline to enforce the mandate?

The short answer is no. The longer answer is more complicated, but it’s also instructive. At key points, President Barack Obama delayed aspects of the ACA in an effort to put health reform on a sound footing. The delays were classic examples of executive overreach; they never should have happened. The Republican-led House of Representatives even sued the president over them.

And now the shoe is on the other foot. With Trump in office, some of Obamacare’s fiercest critics seem almost giddy at the prospect that he might use the same weapon against the act. Pick your favorite tagline: payback is a bitch, what goes around comes around, “I learned it from watching you, Dad!”

What Trump has hinted at, however, would be a far greater overreach than Obama ever attempted. But Obamacare’s critics are unlikely to care. There’s an important lesson here about the accretion of executive power in the 21st century, how law is enforced outside the courts, and what presidential power might look like in an age of Trump.

bhtv-2017-01-31-glass-mcintyre

Earlier this week, Kevin Glass, director of policy at the Franklin Center and contributor at The Washington Examiner, invited me to chat on his Bloggingheads show about the future of the ACA. We touch on the scope and implications of Trump’s executive order, the Cassidy-Collins plan, and the difficult politics of repeal and (particularly) replace. We also spend a fair bit of time talking about the market uncertainty created by those politics, which threatens to undermine access to coverage in 2018, regardless of policy outcome.

Kevin Glass (Franklin Center for Government and Public Integrity) and Adrianna McIntyre (The Incidental Economist)