TrumpCare. “If you don’t know (`or care`) where you’re going, any road will get you there.” – Lewis Carroll

“… Trump’s views about health care have been anything but consistent. Rather, there have been three constants: agnosticism about what a plan should look like; a fanatical desire to notch a win regardless of the quality of that win; and a refusal to give up.
In the meantime, Trump has vacillated frequently, mostly pinging between three incompatible positions: first, that Obamacare should be repealed and replaced; second, that Republicans should repeal Obamacare and worry about a replacement later; and third, as here, that Republicans should simply let Obamacare die. Let’s consider a somewhat simplified timeline of Trump’s views. (A)

Here are three promises Trump made that will not come true under the current bills moving through Congress:
‘Everybody’s got to be covered.’
‘No cuts’ to Medicaid
‘Every bit as good on pre-existing conditions as Obamacare.’ (B)

Mr. Trump usually steers clear of policy details and has grown impatient with the painstaking behind-the-scenes bargaining that has marked the health care negotiations. But he said on Wednesday that he was hopeful that the Senate would deliver a bill that he could sign. (C)

“Republicans should just REPEAL failing Obamacare now & work on a new Healthcare Plan that will start from a clean slate,” the president tweeted, adding that “Dems will join in!” (D)

“Trump’s predictions of collapse and threats to withhold critical government payments to insurers — have obscured an encouraging fact: Many of the remaining companies have sharply narrowed their losses, analysts say, and some are even beginning to prosper…
The insurers that stayed in the individual market have come to realize that the individual market was more like Medicaid than the employer business. Some customers have chronic conditions that have been poorly treated in the past, and insurers need to manage their care more closely. People shopping for a plan are very concerned about price, making it essential for insurers to find hospitals and doctors that provide care at the lowest cost. (E)

Let’s stipulate up front that congressional leaders and President Trump are unlikely to lead that effort, given that they narrowly failed to take health insurance away from millions of people. This conversation would need to be led by senators who have committed to a bipartisan approach, and by state governments, some of which have already begun to take action.
Change might not come soon enough for the 29 million people without health insurance or the many millions who struggle to afford high premiums, deductibles and other health costs.” (F)

Now, a repeal plan proposed by GOP Sens. Bill Cassidy of Louisiana, Lindsey Graham of South Carolina and Dean Heller of Nevada is, as Cassidy put it recently, “about the only game left in town” when it comes to the GOP’s hackneyed promise to repeal and replace Obamacare, as the law is also known…
There’s no compelling rationale for the changes Republicans continue to propose to the nation’s health care policies. It’s clearly not to extend health coverage to more people or to maintain it for those who currently have it. It’s clearly not to make matters easier for the states. And it’s clearly not to tackle the genuine health care problems Americans face, such as staggeringly high costs and inferior outcomes.
With clearly no helpful intentions in mind, Cassidy, Graham and Heller ought to let this Obamacare repeal plan fail like its predecessors. (G)

Next month the Senate will try a novel approach to break away from seven years of polarization on health care: actual committee hearings, with expert witnesses and input from lawmakers in both parties.
And if those go well, Congress could see an even unlikelier development—the advance of viable, bipartisan legislation to fix parts of the Affordable Care Act.
The hearings are the brainchild of Senator Lamar Alexander of Tennessee, the Republican chairman of the Health, Education, Labor, and Pensions Committee, who has been talking for months about the need to stabilize Obamacare’s individual insurance market. What makes this effort different is that following the GOP’s failure to repeal and replace the law, Alexander now has the blessing of his party’s leadership and buy-in from the committee’s top Democrat, Senator Patty Murray of Washington State…
“I’m looking for the simplest bill possible that Republicans and Democrats can agree on that will stabilize the individual insurance market,” Alexander told reporters earlier this month. (H)

“A Trump administration official said Wednesday that the administration wanted to stabilize health insurance markets, but refused to say if the government would promote enrollment this fall under the Affordable Care Act or pay for the activities of counselors who help people sign up for coverage.
The official also declined to say whether the administration would continue paying subsidies to insurance companies to compensate them for reducing deductibles and other out-of-pocket costs for low-income people. Without the subsidies, insurers say, they would sharply increase premiums.
The administration, the official suggested, will do the minimum necessary to comply with the law, which Mr. Trump has called “an absolute disaster” and threatened to let collapse.
“I don’t think we can force people to sign up for the program,” the official said. “ (I)

“But what about ideas that go beyond the oft-repeated ones? Here are five proposals that are more controversial but generating buzz.
1. Allow people into Medicare starting at age 55.
2. Allow people to ‘buy in’ to Medicaid.
3. Get younger adults off their parents’ insurance and back into the individual market.
4. Require insurers who participate in other government programs to offer marketplace coverage.
5. Let people use HSA contributions to pay health insurance premiums. (J)

“Colorado Gov. John Hickenlooper and his Republican counterpart from Ohio, John Kasich, on Thursday morning released their bipartisan plan to stabilize the individual health insurance market.
Among their recommendations:
The Trump administration should commit to making cost-sharing reduction payments to keep premiums from going up 20-25 percent and increasing the federal deficit.
Congress should create a temporary stability fund for states to create reinsurance programs that reduce premiums.
Congress should encourage health insurance companies to enter underserved counties by exempting insurers that do so from the federal health insurance tax on their exchange plans in those counties.
Keep the individual mandate (for now) to prevent the rapid exit of carriers from the market.
Maximize market participation by encouraging young people to get insurance.
Modify and strengthen federal risk-sharing mechanisms, including risk adjustments and reinsurance to stabilize risk pools. (K)

“Last fall, as consumers in Minnesota were facing health insurance rate increases of 50 percent or more, Gov. Mark Dayton, a Democrat, said the Affordable Care Act was “no longer affordable to increasing numbers of people.” The state’s top insurance regulator said the Minnesota market was “on the verge of collapse.”
The outlook now is much better. Rate increases requested for 2018 are relatively modest, thanks in part to a new program under which the state will help pay the largest claims. The program, known as reinsurance, and the efforts that led to its creation hold lessons for other states where rates are rising rapidly, and for Congress, where lawmakers are considering the introduction of a similar program…
But the program will be invisible to consumers. They will not have to file additional paperwork or do anything different from what they would ordinarily do..
Minnesota’s experience with such an effort is instructive. The bill creating its reinsurance program, the Minnesota Premium Security Plan, became law within three months of being introduced — lightning speed when compared with the pace in Congress.” (L)

“Despite the setbacks of the past eight months, including the inability of Republicans to agree on a single alternative to the ACA, it is still not too late for this Congress to pass health care reform legislation…
What united the fractured Democratic members (on ObamaCare) was that they were unified in their desire to pass something that would move the country in the direction of more government control over health care, with fewer individual choices. They differed greatly on the details, and on how far they wanted to push the agenda in that first step. But their agreed on the need to pass something.
Republicans have spent every election cycle since 2010 promising voters that they will push health care in the other direction – favoring more choice and less regulatory control, and as a result, lower costs. With that campaign agenda, they captured the House, then the Senate, and finally the Presidency. Now, with numerous proposals about how to proceed, can they at least agree on the need to pass something?
It doesn’t have to be perfect. It just has to be better than what we have now. With so many American paying so much money for so little in return, that’s really not such a high bar. “(M)

“The Trump administration is slashing spending on advertising and promotion for enrollment under the Affordable Care Act, a move some critics charged was a blatant attempt to sabotage the law.
Officials with the Department of Health and Human Services, who insisted on not being identified during a conference call with reporters, said on Thursday that the advertising budget for the open enrollment period that starts in November would be cut to $10 million, compared with $100 million spent by the Obama administration last year, a drop of 90 percent. Additionally, grants to about 100 nonprofit groups, known as navigators, that help people enroll in health plans offered by the insurance marketplaces will be cut to a total of $36 million, from about $63 million.
The officials said the administration believed that the cuts were necessary because of “diminishing returns” from advertising…” (N)

Senate Republicans will soon run out of time to rely on their slim majority to dismantle the Obama health law.
The Senate parliamentarian has determined that rules governing the effort will expire when the fiscal year ends Sept. 30, according to independent Sen. Bernie Sanders of Vermont, the ranking member of the Senate Budget Committee. The rules allow Republicans to dismantle President Barack Obama’s health care law with just 51 votes, avoiding a filibuster.
Republicans control the Senate 52-48 and were using the special filibuster-proof process in the face of unified Democratic opposition. Now, if Republicans can’t revive the repeal measure in the next four weeks, they will be forced to work with Democrats to change it.” (O)

(A) on Health Care, by David A. Graham, https://www.theatlantic.com/politics/archive/2017/07/as-i-have-always-said-trumps-ever-changing-position-on-health-care/535293/
(B) 3 promises Trump made about health care that repeal plans haven’t kept, by Eliza Collins, https://www.usatoday.com/story/news/politics/2017/06/24/promises-trump-made-health-care-repeal-plans/426089001/
(C) Trump Demands That Senators Find a Way to Replace Obamacare, By JULIE HIRSCHFELD DAVIS, THOMAS KAPLAN and MAGGIE HABERMAN, https://www.nytimes.com/2017/07/19/us/politics/donald-trump-obamacare-health-care-republicans-senators.html?mcubz=0
(D) As Health Care Bill Stalls, Trump Calls For Outright Repeal Of Obamacare, Nick Visser, http://www.huffingtonpost.com/entry/trump-health-care-bill-response_us_596d719ee4b010d7767345ff
(E) Trump’s Threats on Health Law Hide an Upside: Gains Made by Some Insurers, by REED ABELSON, https://www.nytimes.com/2017/08/26/health/obamacare-market-insurance.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(F) Looking Beyond the Obamacare Debate to Improve Health Care, https://www.nytimes.com/2017/08/26/opinion/sunday/obamacare-universal-health-coverage.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(G) Senate GOP trio offer another Obamacare repeal plan that deserves to fail, https://bangordailynews.com/2017/08/28/opinion/editorials/senate-gop-trio-offer-another-obamacare-repeal-plan-that-deserves-to-fail/?ref=OpinionBox
(H) The Senate Tests a New Approach on Obamacare: Bipartisanship, by RUSSELL BERMAN, https://www.theatlantic.com/politics/archive/2017/08/the-senate-tries-a-new-approach-on-obamacare-bipartisanship/538083/
(I) Trump Administration Wants to Stabilize Health Markets but Won’t Say How, by By ROBERT PEARAUG, https://www.nytimes.com/2017/08/30/us/politics/trump-obamacare-enrollment-markets-subsidies.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(J) 5 Outside-The-Box Ideas For Fixing The Individual Insurance Market, by Julie Rovner, http://khn.org/news/5-outside-the-box-ideas-for-fixing-the-individual-insurance-market/
(K) John Hickenlooper, Ohio Gov. John Kasich release their bipartisan plan to address health care, by JESSE PAUL, http://www.denverpost.com/2017/08/31/john-hickenlooper-ohio-gov-john-kasich-release-their-awaitied-bipartisan-plan-to-address-health-care/
(L) Minnesota Finds a Way to Slow Soaring Health Premiums, by ROBERT PEAR, https://www.nytimes.com/2017/09/02/us/politics/minnesota-health-care-reinsurance.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(M) It’s Not Too Late To Reform Health Care – The ACA Took Longer, by Robert Book, https://www.forbes.com/sites/theapothecary/2017/08/31/its-not-too-late-to-reform-health-care-the-aca-took-longer/2/#5aadf4ba1c7b
(N) Trump Administration Sharply Cuts Spending on Health Law Enrollment, by ABBY GOODNOUGH and ROBERT PEAR, https://www.nytimes.com/2017/08/31/health/affordable-care-act-trump-spending.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(O) GOP ability to dismantle health law expires at month’s end, http://abcnews.go.com/Politics/wireStory/gop-ability-dismantle-health-law-expires-months-end-49571509

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