REPEAL NOW/ REPLACE LATER: “Nothing like rolling a hand grenade into ongoing negotiations…”

…….The President’s tweet also could have the effect of further complicating health care negotiations. A GOP official close to leadership and supportive of the current repeal/replace effort told CNN.” (A)

President Trump tweeted: “If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” (B)

Senate Majority Leader McConnell immediately rejected the idea and …”riffed on Trump’s winning campaign slogan, saying, “It’s not easy making America great again is it?”” (C)

“The logic makes some sense, in the abstract. If Democrats are confronted with Obamacare being ripped out, root and branch, would they really not work with Republicans to restore funding to things like Medicaid?
The problem is that legislating health care, as we’ve found out, is a hugely messy process. Any replacement of funding would be subject to debate and would face an uncertain future. Democrats might hold out for more Medicaid funding. Republicans might hold out for less Medicaid funding or hold the line on something like cutting off Planned Parenthood. The GOP would essentially be gambling that Congress would have to pass something, thereby absolving them of whatever harmful effects might come from cutting off the Affordable Care Act in one fell swoop.
But we’ve been down this road before, to some degree, and the lesson is clear: Never underestimate Congress’s ability to gridlock itself.” (D)

In January before leaving Office President Obama called Repeal Now/Replace Later “reckless” and “irresponsible.” “Given that Republicans have yet to craft a replacement plan, and that unforeseen events might overtake their planned agenda, there might never be a second vote on a plan to replace the ACA if it is repealed,” Obama wrote. “And if a second vote does not happen, tens of millions of Americans will be harmed.” “(E)

Repeal alone….”would probably leave 18 million more people without coverage in the first year after its enactment and 32 million more by 2026, according to a Congressional Budget Office report that looked at an earlier GOP bill to repeal Obamacare.
It would also cause premiums on individual market policies to increase by up to 25% the first year and to nearly double by 2026.
All this would happen mainly because the individual mandate — which requires nearly all Americans to get coverage or pay a penalty — would be repealed. But some insurers would also likely pull out of the market, the CBO said. The remaining carriers would likely raise rates dramatically because the remaining enrollees would tend to be older and sicker.” (F)

“Repeal of the ACA hurts employer-based insurance. With tens of millions of people no longer insured via Medicaid expansion and subsidies, hospitals and doctors would find themselves back in the bad-old-days of uncompensated care and inadequate pools to support their free care. There will be nowhere else to turn for resources than to higher premiums for people who do have insurance.”….” Bottom line: if you think your employer-based premiums went up too much under the ACA, just wait until it’s gone to see what the ACA was actually protecting you from.” (G)

“Senate Republican leaders trying to break a logjam on their proposed health-care legislation are working with congressional budget officials to examine the impact of various changes they’re considering, a process that could take about two weeks, according to a GOP aide….(H)

Here’s one columnist’s small ball proposal:
“First, the smaller bill would repeal the individual mandate requiring the purchase of health insurance. It would replace it, as the Senate bill does, with a continuous-coverage requirement — a waiting period to purchase insurance if you go without it for more than two months.
Second, the bill would repeal some of the taxes on health care spending, saving and services imposed by Obamacare — including the taxes on medical devices and prescription medications, the higher threshold for deducting spending on chronic care, and the limits on contributions to health spending accounts.
Third, the bill would maintain the stabilization funds that the Senate legislation pays to states and insurers to help cover the sickest Americans and keep exchange prices from spiraling upward. (I)

Congress has three weeks to get this right between its July 4th recess and its month-long August recess.

(A) Trump: If GOP health care bill fails, repeal Obamacare now, replace later, by Eugene Scott,
(B) Trump to Senate Republicans: kill Obamacare now, replace later, by Doina Chiacu and Susan Cornwell,
(C) McConnell rejects Trump’s advice to repeal ObamaCare now, replace later,
(D) Trump’s new idea to repeal Obamacare now and replace it later would be a massive gamble, by Aaron Blake,
(E) President Barack Obama Slams ‘Repeal And Delay’ Approach To Affordable Care Act, by Anna Almendrala,
(F) 32 million people would lose coverage if Obamacare was repealed, by Tami Luhby,
(G) What Happens If Republicans Repeal Without A ‘Replace’?, by Donald M. Berwick,
(H) Senate GOP Leaders Said to Aim for New Health Plan in Two Weeks by Laura Litvan , Elizabeth Titus , and Steven T. Dennis,
(I) Going Small on Health Care by Ross Douthat,

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