Obamacare repeal vote upends 2018 House landscape – By ALEX ISENSTADT and GABRIEL DEBENEDETTI 05/06/17

Republicans worry their incumbents will pay for the vote, and signs abound of an energized Democratic base.

American Action Network, a super PAC aligned with House Speaker Paul Ryan, has begun airing TV ads in the districts of 21 Republicans who voted for the bill that aim to generate public support for the legislation. | Getty

This week’s vote to replace Obamacare has scrambled the 2018 House landscape, jeopardizing Republican lawmakers across the country and potentially endangering the party’s longstanding grip on the chamber.

More than a dozen senior Republican strategists, lawmakers, and potential candidates expressed varying degrees of concern over the political implications of the health care push. Some predicted that House members would face a fierce backlash from voters, while others said the party had erred badly in rushing through a bill that lacked broad public support.

The vote, combined with President Donald Trump’s record-low poll numbers and rising public dissatisfaction with how Republicans are wielding power over the federal government, has produced a cauldron of instability for the party, which is holding onto a 24-seat edge in the House. There is also the weight of history: In every midterm election since 2002, the party in the White House has lost congressional seats.

Some Republicans said the political environment surrounding the chamber had become more unpredictable than at any point since 2010, when they took power in an historic 63-seat wave.

“With this vote or not, we were headed to one of the most competitive, shifting, and volatile mid-year congressional elections in a number of years,” said Nick Everhart, a veteran Republican strategist who is working on a number of 2018 contests. “Between open seats, candidate recruitment, and legislative battles to come there are still so many variables that are going to shape the playing field.”

Several operatives said they were spending the end of the week trying to gauge fallout after some House Republicans admitted in televised interviews that they hadn’t read the full bill before voting for it — footage that could well appear in Democratic commercials come next year.

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Republicans may not want POTUS to end Obamacare payments – By Paige Winfield Cunningham April 14 at 4:15 PM

Rep. Tom Cole (R-Okla.) (J. Scott Applewhite/AP)

Some influential Republicans in Congress don’t want a fight President Trump is threatening to pick over extra Obamacare payments to insurers.

Trump suggested this week that as Congress seeks to fund the government beyond April, Republicans should refuse to pay for cost-sharing subsidies provided through the Affordable Care Act to low-income Americans. There’s widespread agreement that without the subsidies, insurers would be forced to hike premiums next year, worsening conditions in the Obamacare insurance marketplaces.

The president told the Wall Street Journal on Wednesday that not only would such a move cause Obamacare to “die,” it could also be used to force Democrats to negotiate on repealing the health-care law altogether. “Without the payments, Obamacare is gone, just gone,” Trump said.

[Trump’s threat prompts Democrats to play hardball over Obamacare payments]

Many Republicans are well aware that the public is likely to blame them for premium increases, now that they control both Congress and the White House and have so far failed to agree on a health-care replacement plan. And Democrats are keenly aware of the shifting dynamics, seizing every opportunity they can to insist Republicans now own the health-care law.

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More than half of Americans approve of Obamacare now, Gallup poll finds – by Tami Luhby April 5, 2017: 2:42 PM ET

Obamacare is more popular now than it was on Election Day, despite President Trump and the GOP’s efforts to dismantle it.

Some 55% of Americans now support the Affordable Care Act, up from 42% in November, a new Gallup Poll found. This is the first time that a majority of Americans have approved of the health reform law since Gallup asked in November 2012.

The Gallup poll results are more positive than some other polls, though all have shown an uptick in support of the law since the election. A new Kaiser Family Foundation poll found 46% of respondents have a favorable opinion, down a bit from its March survey, but up from the 43% in November.

Americans’ view of Obamacare are split along party lines, though all groups view the law more favorably now, according to Gallup. Some 86% of Democrats and 57% of independents approve it, while 17% of Republicans do. But, in November, only 7% of Republicans felt this way.

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Obamacare: Last Week Tonight with John Oliver (HBO) – Published on Feb 26, 2017

Congressional Republicans could soon vote to repeal Obamacare.
John Oliver explores why their replacement plans are similar to a thong.

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Meet The Republican Governors Who Don’t Want To Repeal All Of Obamacare – NICK CASTELE January 23, 2017 4:53 AM ET


Ohio Governor John Kasich at a White House event in Nov. 2016. in Washington, DC. President Obama hosted the Cavaliers to honor their 2016 NBA championship. | Cheriss May/NurPhoto via Getty Images

As Congressional Republicans begin work on repealing the Affordable Care Act, many of the nation’s governors want to make sure that their state budgets don’t take a hit during the dismantling process.

They’re most concerned about Medicaid, the health insurance program for the poor that’s run jointly by the states and federal government. As a result of a Supreme Court decision, states were allowed to decide whether they would expand Medicaid under the ACA. 14 million people have gained health insurance coverage through Medicaid since eligibility for the program was expanded.

While 19 states declined the expansion, primarily due to the opposition of Republican governors and lawmakers, several Republican governors did choose to expand the program. Now they’re lobbying to keep their citizens covered and billions of dollars of federal Medicaid money flowing.

Among them is Ohio Gov. John Kasich who, along with several other Republican governors, met with GOP members of the Senate Finance Committee last week for a closed-door discussion about the healthcare law.

Kasich has been anything but quiet on the subject.

In a letter to Congressional leaders, Kasich recommended that Medicaid expansion not be repealed, while indicating he’s open to some changes, such as in income eligibility. Kasich urged Congress in an op-ed on Time.com to pass an Obamacare replacement at the same time as a repeal.

“For the millions of Americans who have gained health coverage since 2010, it’s safe to assume that their idea of fixing Obamacare does not involve ripping away their own health care coverage without a responsible alternative in place,” wrote Kasich.

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What we know and don’t know about the President’s healthcare plans – BY PETER SULLIVAN – 01/22/17 06:00 PM EST

The President told Fox News last week that when it comes to ObamaCare, “we’re going to have a plan that’s going to be great for people.”screen-shot-2017-01-23-at-jan-23-2017-2-11

What that plan will actually be, though, remains unclear.

The President has said that he will put forward an ObamaCare replacement plan shortly after Rep. Tom Price (R-Ga.) is confirmed, an announcement that caught lawmakers off guard.

If The President actually follows through on putting forward his own plan, rather than letting Congress take the lead, it could provide some guidance to Republican efforts to come up with an ObamaCare replacement, though lawmakers are sure to want their own say on any plan as well.

The President has dropped a few hints on his ideas for a replacement plan.Here’s a guide to what we know and don’t know.

He wants to cover everyone

What we know: ThePresident  made waves last week when he told The Washington Post he wants everyone to have insurance.

“We’re going to have insurance for everybody,” The President  said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

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IUDs and Mammograms Are Free Under Obamacare. How Much Will You Pay If It’s Repealed – By Christina Cauterucci JAN. 18 2017 6:12 PM

The median cost of a Mirena IUD across the country is $1,111. Without the Affordable Care Act, people with insurance may have to pay the full price for what they now get for free.

If Republicans succeed in their plan to repeal the Affordable Care Act, our current era of affordable birth control will likely end. The ACA requires insurers to fully cover the cost of contraception and preventive health care like cancer screenings, making them free to all insured patients.

Senate Republicans have indicated that they hold no part of the ACA sacred, even the popular provisions that guarantee maternity care coverage and no-cost contraception. Last week, they shot down an amendment that would have protected both. That means a lot of people who currently get birth control for free may soon have to pay out of pocket for some or all of the costs. Preventive services like routine mammograms also stand to get a lot more expensive.

The exact amount charged to the patient will vary based on her insurance plan, but doctor-database site Amino has mapped out the median network rate estimates (that is, the rate an insurance company negotiates with providers on behalf of patients) for intrauterine devices and mammograms in all 50 states and D.C. The report notes that since 51 percent of workers with private insurance have an annual deductible of at least $1,000, patients could conceivably be on the hook for most or all or most of the cost of these services if the ACA goes away.

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President-Elect, GOP at crossroads on repealing ObamaCare – BY PETER SULLIVAN – 01/10/17 08:33 PM EST

In a significant development, President-elect Donald Trump on Tuesday called on Republicans to pass an ObamaCare replacement within “weeks” after repeal.

#Greg Nash

#Greg Nash

Trump’s comments urging his party to act quickly on a replacement come as a growing group of congressional Republicans is expressing serious concerns about moving forward quickly on repeal without having a replacement plan ready, or at the least the outlines of one.

Just weeks ago, Republicans had floated the possibility of passing a replacement bill two or even three years down the road.

“Long to me would be weeks,” Trump told The New York Times on Tuesday. “It won’t be repeal and then two years later go in with another plan.”

However, Republican congressional leaders have declined to commit to passing a replacement in “weeks” or providing any specific timeline beyond sometime this year. They are still moving forward with their plan to pass a repeal of the law before a full replacement is ready.

Senate Majority Leader Mitch McConnnell (R-Ky.), asked about Trump’s comments, declined to commit to a timeline for a replacement, saying that the process is still being worked out.

“We’ll be working with the president’s nominees, Tom Price, Seema Verma, who’ll be helping us craft the way forward,” McConnell said, pointing to two of Trump’s Department of Health and Human Services nominees.

After meeting with House Republicans behind closed doors on Tuesday, Speaker Paul Ryan (R-Wis.) told reporters, “It is our goal to bring it all together concurrently. We’re going to use every tool at our disposal through legislation, through regulation, to bring replace concurrent along with repeal, so that we can save people from this mess.”

Nearly seven years after the passage of the Affordable Care Act, some Republican lawmakers also acknowledge that they have much work to do on a replacement and would likely not be ready to put forward a replacement plan on Trump’s timeline of “weeks” after a quick repeal anyway.

Sen. Bill Cassidy (R-La.) is one of five Republican senators pushing to delay the deadline for a repeal bill from Jan. 27 to March 3 to give more time to work on a replacement.

“Clearly if we go by the 27th of this month, the four major elements that we have to resolve, we won’t have time to resolve,” Cassidy said. “Those being: What can Tom Price do? How do we pay for it? What is the blueprint or the pathway forward for repeal? We  may need something that needs a 60-vote threshold.”

Senate Majority Whip John Cornyn (R-Texas) pushed back on this idea of a delay, though, saying it could clog up the Senate schedule and cause a “jam” for legislation.

Republican leaders in both chambers on Tuesday mentioned the possibility of including some elements of a replacement plan in the repeal measure. But they were not specific about which elements those would be, and it appears that Trump was talking about speedy action on a full replacement, not just elements of it.

“I think there could be elements of a replacement included in a first reconciliation bill,” Sen. John Thune (S.D.), the No. 3 Senate Republican, said when asked about Trump’s comments.

“We’re in the process of sorting out the timing of it,” he acknowledged. “But everybody’s agreed that it has to be repealed and it has to be replaced with something better.”

Putting forward a detailed replacement plan would be a tough task for Republicans, forcing them to confront tradeoffs on cost and answer questions like whether their plan would cover as many people as ObamaCare.

Republican leaders have so far declined to commit to covering as many people as ObamaCare, meaning some of the 20 million covered by the law could lose their insurance.

Congressional Republicans are also split on whether to immediately repeal ObamaCare’s tax increases, with some worrying about the lost revenue, while conservatives push to repeal as much as the law as possible.

On Friday, Sen. Rand Paul (R-Ky.) tweeted that he talked to Trump, adding that the president-elect “fully supports my plan to replace ObamaCare the same day we repeal it.”

Many healthcare experts have warned that the current congressional strategy to repeal the law, even on a delay, without having a replacement ready would plunge the health system into chaos. Insurance companies, for example, could drop out of the marketplace due to uncertainty, reducing or eliminating altogether coverage options for people, or hiking their premiums.

Some Republican lawmakers are also echoing those concerns.

“I’m not alone,” Sen. Bob Corker (R-Tenn.) told reporters Tuesday. “There are a lot of people y’all have written about and then a whole lot more beyond that that you haven’t written about that have concerns about doing a repeal with no replacement, or at least some guidance on a replacement.”

Still, no Republican senator has said yet that he or she will vote against the repeal bill, and several with concerns expressed hope that more details could bring them on board.

“Yeah, as long as I know that there’s a pathway forward,” Cassidy said when asked if he would vote for the eventual repeal bill. “I think we’re in the development of it, I would just like to have it a little further fleshed out.”

The first step to setting up the fast-track repeal process is passing a budget this week.

The conservative House Freedom Caucus expressed concern about voting on Friday without having more details on repeal and replacement, but leaders are going forward with the vote.

Freedom Caucus members have not taken an absolute stand and still could come around.

If some replacement elements are included in an initial repeal bill, as Ryan indicated Tuesday, it is not clear what they would be.

Throughout his two terms, President Obama has consistently jabbed Republicans for not coalescing behind a replacement bill.

Some GOP lawmakers have mentioned expanding the use of health savings accounts or regulatory action to loosen ObamaCare’s rules for what services insurance plans must cover.

But Republicans have much work to do on a full replacement, and Democrats are already accusing them of repealing the law while essentially hiding their plan to replace it.

Rep. Chris Collins (R-N.Y.), a close Trump ally, said Tuesday afternoon that more than 23 Republicans spanning from the centrist Tuesday Group to the conservative Freedom Caucus were expressing trepidation about voting to repeal the law without a replacement.

“We do have members who feel if we don’t do them together, the replacement may never happen,” Collins said.

Jordain Carney and Cristina Marcos contributed.

Sanders: GOP ‘damn well’ needs ObamaCare replacement – BY MARK HENSCH – 01/09/17 10:09 PM EST

 Sen. Bernie Sanders (I-Vt.) says Republicans cannot repeal ObamaCare without having an alternative first.

Sen. Bernie Sanders (I-Vt.) says Republicans cannot repeal ObamaCare without having an alternative first.

“I’m going to do everything I can – and I believe I speak for virtually every member of the Democratic Caucus – that we’re going to do everything we can to improve the Affordable Care Act [ACA],” he said during a CNN town hall at George Washington University in Washington, D.C., on Monday. “It has problems.”

“But we damn well are not going to see it repealed and have no replacement there at all,” added Sanders, who unsuccessfully sought the 2016 Democratic presidential nomination.

Senate Democrats took to the floor late Monday to protest the GOP’s plan to repeal ObamaCare without an immediate replacement.

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Obamacare repeal’s doomsday scenario – By Paul Demko and Adam Cancryn 01/09/17 05:07 AM EST

Shocks to the $3 trillion-a-year health system could send ripples through the entire economy.

“That transition period is going to be like that slow-moving tsunami that we know is coming," says one expert. | Getty

“That transition period is going to be like that slow-moving tsunami that we know is coming,” says one expert. | Getty

Hospital and health plan leaders talk in almost apocalyptic terms about what might lie ahead if Republicans abolish Obamacare without a blueprint for its replacement.

Their doomsday scenario: Millions of people could lose their health care coverage, hospitals could hemorrhage cash and shocks to the $3 trillion-a-year health system could send ripples through the entire economy.

“That transition period is going to be like that slow-moving tsunami that we know is coming, and we can watch it and try to prepare for it — but in the aftermath of the tsunami, there’s devastating loss that we never could have planned for,” said Heidi Gartland, vice president for community affairs and government relations at Cleveland-based University Hospitals Health System.

Hospitals estimate that repealing Obamacare could cost them $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis” if sick people are unable to get care. Even before that happens, though, uncertainty about what might replace the law and how it could affect the bottom lines of hospitals, in particular, has spurred CEOs to cut spending.

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