“Here are the five ways President Trump could weaken the ACA in 2018….easing ACA regulations on association health plans and extending short-term coverage….Continue outreach cuts….Target the essential health benefits…4. Allow insurers to leave counties….5.Not support ACA stabilization bills. The Alexander-Murray market stabilization bill and a reinsurance proposal from Sen. Susan Collins, R-Maine, have received support from Senate leadership, but unless President Trump pressures the House to support the measures, they have a much lower chance of passing into law.” (A)
“After a year in which Obamacare’s fate hung by a thread, 2018 is likely to feature fewer mortal threats. But the next 12 months could still be a tumultuous period as insurers, customers and elected officials react to major changes to the law by the Trump administration and the Republican Congress….
The new tax bill eliminates the individual mandate, a key pillar of the ACA. Trump’s White House is pursuing new regulations that could undermine Obamacare plans with cut-rate alternatives. Some states are struggling to attract insurers, a problem that’s carried over from the Obama era. Republicans are still debating whether to give the ACA a bipartisan tune-up or purposefully “let Obamacare fail,” as the president has put it. And nobody is sure what surprises the year might bring.” (B)
“President Donald Trump is predicting that Democrats and Republicans will “eventually come together” on a new health care plan for the country.
Sending a Twitter post early Tuesday from his Florida resort, Trump said “the very unfair and unpopular Individual Mandate has been terminated as part of our Tax Cut Bill, which essentially Repeals (over time) Obamacare.”
Based on the fact that the very unfair and unpopular Individual Mandate has been terminated as part of our Tax Cut Bill, which essentially Repeals (over time) ObamaCare, the Democrats & Republicans will eventually come together and develop a great new HealthCare plan!” (C)
“Surpassing nearly everyone’s expectations, more than 8.8 million Americans signed up for ObamaCare this year. Simple marketplace demand prevailed over convoluted Republican attempts to deter enrollment and repeal ObamaCare. With generous federal subsidies offering significant savings, Obama’s signature healthcare law may have provided the best economic deal for millions of Americans, transcending politics.
Even Trump’s own supporters could not resist signing up.
In an ironic twist of events, more than 80 percent of Americans enrolling in ObamaCare this year come from states that Trump won in the 2016 election. The top four states with the largest number of sign-ups, namely Texas, Georgia, Florida, and North Carolina all hail from the deep red South and all went for Trump.
In retrospect, this should not come as a surprise. The same voters who propelled Trump to an Electoral College victory, mainly the older white voters in rural America and whites without a college degree, are the same groups of people who stand to benefit the most from ObamaCare.
This is especially the case in rural areas where healthcare costs are higher due to fewer insurance companies offering coverage. Less competition leads to higher premiums, an issue ObamaCare specifically remedies with federal subsidies. Trump’s own supporters therefore put their economic self-interest over their allegiance to party politics. They chose the cheapest health insurance available that offset these unfair costs.
They chose ObamaCare.” (D)
“President Trump and his allies in Congress failed in their effort to “repeal and replace” Affordable Care Act (ACA), so they have settled upon a “wreck and rejoice” strategy instead…
If the repeal of the mandate was supposed to be a dagger in the heart of Obamacare, it missed its mark. The heart of Obamacare still beats. The insurance exchanges remain in place, as does the expansion of Medicaid coverage.
The Congressional Budget Office estimates, however, that there will be 4 million fewer people will have insurance coverage by 2019, and by 2027, there will be 13 million fewer enrollees. As a result, insurance premiums for enrollees will be 10 percent higher by 2027 than they would have been otherwise.
Whether or not the repeal of the mandate wrecks the ACA, it is hardly cause for rejoicing. Not long ago the President was bragging about creating a “beautiful” replacement for Obamacare that would provide broader and better coverage.
That thought, however “beautiful” it was in its conception, has now been abandoned in favor of maiming the ACA by any means possible.
Repeal of the ACA’s enrollment mandate will be especially harmful with respect to contraceptive coverage. The CBO’s report does not give us a breakdown of the 13 million people who, by 2027, will not be enrolled in an insurance plan, but many of them will be younger people who elect to drop their coverage once the tax penalty for non-enrollment is lifted.
And many of them will be women who might otherwise benefit from the ACA’s “contraceptive mandate.” (E)
“States are likely to get more power to set Obamacare coverage requirements under a Department of Health and Human Services proposed rule likely to be finalized in early 2018.
Comprehensive essential health benefits (EHBs) that health plans are required to cover under the Affordable Care Act are generally based on the largest small business health plans operating in each state. Under the proposed rule, state insurance regulators in the 39 states that use the federal HealthCare.gov exchange could choose categories of benefits from health plans offered in other states, or they could come up with their own set of benefits with approval from the HHS.
States that are struggling to maintain individual market coverage under the ACA may try to reduce premiums by looking for plans in other states where benefits are skimpier….
“The EHB flexibility allows so much mixing and matching that it could be used to patch together a plan that is not representative of employer-based coverage as required by the statute,”… “We do not want to go back to days when individual coverage was inferior to group coverage,” as was the situation before the ACA took effect in 2014,… (F)
“Health insurance companies that stuck with providing individual coverage under the Affordable Care Act will divvy up the spoils next year thanks to departures of rivals Aetna, Anthem, UnitedHealth Group and Humana from key markets.
With less competition and the benefit of double-digit percentage price increases, Centene, Cigna, Oscar Health and Blue Cross and Blue Shield plans stand to benefit from the ACA in 2018 .
Oscar enrolled more than 250,000, or a 150% increase in individual customers in its individual plans , the company said last week. Regional health plans like Medica, Kaiser Permanente and others also are expected to grow in 2018 from the ACA.
Nationally, enrollment was ahead of expectations and not far off last year’s total even though the Donald Trump administration cut the sign-up period in half. More than 8.8 million Americans signed up to individual coverage for 2018 via the ACA’s exchanges or slightly below last year’s 9.2 million.
“Given the generally healthy appearance of marketplace enrollment, carriers like Centene who doubled down on serving the subsidized population are probably feeling reassured,” said Katherine Hempstead, who directs the Robert Wood Johnson Foundation’s work on health coverage issues. “For those who count on the off exchange market as well the outlook is a little less clear.”” (G)
“Before Congress left Washington for the year, Republicans finally made good on their determination to knock big holes in the Affordable Care Act, crippling its requirement that most Americans carry health insurance and leaving insurers without billions of dollars in promised federal payments.
At the same time, public support for the perennially controversial law has inched up to around its highest point in a half-dozen years. Nearly 9 million people so far have signed up for ACA health plans for 2018 during a foreshortened enrollment season, far surpassing expectations.
This dual reality puts the sprawling ACA – prized domestic legacy of the Obama era, whipping post of the Trump administration – at a new precipice, with its long-term fate hinging on the November midterm election certain to consume Washington once the New Year begins. If Democrats win a majority in either chamber of Congress, the law would be protected; a Republican sweep could further embolden repeal attempts…
“To those who believe – including Senate Republican leadership – that in 2018 there will not be another effort to repeal and replace Obamacare – well you are sadly mistaken,” Sen. Lindsey O. Graham, R-S.C., tweeted last week.
Graham’s vow was a rejoinder to Senate Majority Leader Mitch McConnell, R-Ky., who suggested in an NPR interview that “we’ll probably move on to other issues.” He also noted that the chamber’s already-slender Republican majority will shrink to one senator once the Democratic winner of a special election in Alabama is sworn in next month.
McConnell reiterated his intention to try to coax the Senate early in the year to adopt two measures, promised to a crucial Senate Republican moderate in exchange for her support of the massive tax overhaul enacted last week, that would help cushion ACA insurance marketplaces….(H)
“President Donald Trump has said the GOP’s tax bill “essentially repealed” Obamacare. He’s wrong — the Affordable Care Act (ACA) will survive 2018 at least semi-intact. It’s probably not going to thrive, though.
The worst-case scenario for the law — a partial repeal paired with deep cuts to Medicaid — was averted after the GOP couldn’t muster 50 votes for a series of bills in the Senate. The election of Doug Jones in Alabama and signals from Senate Majority Leader Mitch McConnell suggest another bite at that particular apple is not forthcoming. But that was only a partial escape. The Trump administration’s treatment of the individual insurance market has ranged between neglect and sabotage. It cut funding for ACA advertising and enrollment-assistance efforts, shortened the enrollment period, and stopped payment of an insurer subsidy. That was enough to help boost premiums — though it doesn’t appear to have hurt enrollment as much as some might have expected. The toxic cherry on top was the GOP tax bill’s effective repeal of the ACA’s individual mandate. This will be a blow starting in 2019. Fewer people will sign up for insurance on the exchanges (and in general). The people that do sign up and stick with their insurance will tend to be sicker. That will make exchange participation increasingly expensive and risky for insurers. The CBO projects mandate repeal will cut 13 million from insurance rolls by 2025.” (I)
“Republicans have been asking themselves what they’ll turn to next, after their tax overhaul wraps up. If they repeal the Affordable Care Act’s individual mandate, there’s a good chance the answer will be health care — whether they like it or not.
What they’re saying: President Trump has said several times that he wants to take another crack at repeal-and-replace after the tax bill. GOP leaders in the House and Senate have not echoed that plan. But if Republicans do end up repealing the individual mandate, Insurance markets will begin to feel the effects quickly, leading to almost immediate nationwide upheaval that will be impossible to ignore — especially in an election year.
This year saw a lot of chaos — insurers pulling out of markets, coming back in, changing their premiums at the last minute — due in large part to changes that would pale in comparison to something on the scale of repealing the individual mandate.
“I think next year will be even crazier” if the coverage requirement goes away, the Kaiser Family Foundation’s Larry Levitt says.
The timing: The disruption caused by repealing the individual mandate would start early next year and intensify again just before next year’s midterm elections.
The Senate’s tax bill would eliminate the ACA’s penalty for being uninsured, starting on Jan. 1, 2019. That might seem like a long way away, but it’s not.
Insurers will start deciding this coming spring whether they want to participate in the exchanges in 2019 — and if so, where. Without the mandate, insurers would likely begin to pull back from state marketplaces early next year, likely leaving many parts of the country with no insurance plans to choose from.
Insurers will then have to finalize their 2019 premiums next fall. Those rates would likely be substantially higher (10% higher, on average, according to the Congressional Budget Office) without the mandate in place — and that news would hit just before next year’s midterms.
The bottom line: All this fallout would be impossible to ignore, putting more pressure on Congress to return to health policy whether it wants to or not — and reopening all the same internal divisions that have stymied every other health care bill.” (J)
“As I wrote earlier this year, Republicans want less government, Democrats want more. Substantive reforms cannot do both. If lawmakers wish to pass substantive reforms, and the argument that it’s necessary to do so is sound, they must realize they will not be able to find enough common ground to proceed, even now with repeal of the individual mandate. No policy crisis is big enough to bridge the ideological gap between Democrats and Republicans.
As our healthcare system’s struggles worsen, the president is certainly right that Congress will be forced back to the negotiating table.
But any hopes of lawmakers crafting a “great new HealthCare plan” with serious bipartisan support are misplaced. Whatever solutions ultimately pass will either be on a smaller scale or determined entirely by the party in control.” (K)
“There is a relatively simple solution, if states are willing to embrace it. They can fill the gap by passing their own individual mandates that apply within their borders, keeping the essential elements of the Obamacare system intact as far as their jurisdiction extends. In fact, states could make Obamacare work better than it had before, applying a larger penalty than the relatively small one that people have so far faced for skipping out on their responsibility to keep themselves covered. This would encourage more young and healthy people to enter the insurance market, thereby restraining premiums and boosting enrollment.
There would be challenges. States would have to move very quickly to reassure insurers before the 2019 enrollment season. New mandates would have to pass through state legislatures, a tough and perhaps lengthy political process. States that do not collect income taxes would have to devise some minimally onerous way to charge penalty payments. Political and ideological opposition means that many Republican-led states are more likely to choose chaos than they are to fix Obamacare. The result would be a further bifurcation of the U.S. health-care system into states that prioritize expanding coverage and those that prioritize attacking Obamacare.
But the bottom line remains: Not everyone must suffer from Congress’s irresponsibility. States can fix the problem Republicans are creating. They should do so, now.” (L)
“Republicans have no health care message — none. More talk about free market solutions to health insurance costs — such as tort reform, allowing people to buy insurance across state lines, and so on — does nothing to address the acute problem that households are facing as they attempt to balance their monthly budgets.
Worse, every time the Republicans have tried to pass a bill in Congress specifically addressing health care, they have failed, miserably.
Structurally, the Republicans still have an advantage in the 2018 midterms. They only have eight Senate seats up for re-election, as opposed to the Democrats’ 25. And the congressional district maps drawn after 2010 still favor the GOP, even if some incumbents face tough races in districts that voted for Hillary Clinton. Tax cuts will help, as will Trump’s other policy successes. And the radicalism of the left’s so-called “Resistance” will alienate some voters.
But all of those factors together may not outweigh health care as a deciding issue in the midterm elections. Voters, at least beyond the primary phase, are not interested in punishing failure as much as in finding solutions. Democrats are appealing to the electorate with the false promise of other people’s money.
Republicans have no alternative yet. Unless they can find a way to address the urgent needs of patients, they will lose Congress, and deservedly so.” (M)
“Congressional Republicans will open their 2018 legislative agenda wrangling over a politically dicey and very familiar issue: Obamacare.
Moderates want to bolster the Affordable Care Act, especially in the face of possible new hikes in premiums for insurance consumers.
Conservatives want to take another shot at killing the 2010 health care law, even though the GOP’s attempts to do that consumed much of 2017 and ended in an embarrassing failure…
This time around, Republicans will face more pressure to act, especially in the Senate. That’s because Senate Majority Leader Mitch McConnell, R-Ky., promised a key GOP moderate he would push for passage of two bills designed to stabilize Obamacare and keep premiums down in the individual insurance market…
McConnell originally promised Collins that he would push the two bills through Congress last month. But that plan faced stiff opposition in the House, where Speaker Paul Ryan, R-Wis., said he was not bound by McConnell’s agreement.
Conservatives in the House are staunchly opposed to any legislation that would prop up Obamacare. They say the Alexander-Murray proposal is a bailout for insurance giants.
Other Republicans say they should turn back to repealing Obamacare all together and replacing it with a GOP alternative. McConnell has suggested he would only revisit a repeal-and-replace bill if he was sure it would pass the Senate — a steep challenge given that Republicans will only control 51 votes chamber starting Wednesday, when a newly elected Democrat, Doug Jones of Alabama, is sworn in.” (N)
“Workers would be allowed to band together to buy health insurance under a proposed rule released Thursday by the Department of Labor.
The proposed rule was issued in response to an executive order by President Trump, which would allow associations of workers to purchase cheaper health insurance that’s not subject to the same rules as plans under ObamaCare.
By allowing groups of people to purchase plans not subject to ObamaCare’s rules for coverage, however, critics say the move could allow insurers to sell plans that do not cover pre-existing conditions or offer certain “essential health benefits.”
The requirement that insurers cover people with pre-existing conditions was a hallmark of the Affordable Care Act, and a provision that is broadly popular.” (O)
“Congress has no choice but to revisit the issue. The growth in spending on health-care entitlements like Medicaid and Medicare threatens to overwhelm the Treasury, starving the federal government of the funds it needs to pay for everything else, including education, welfare and national defense.
Sen. McConnell said last month that any bill to reform entitlements will need to be bipartisan. He’s right that getting Republicans and Democrats to cooperate is the most sustainable way to pass such legislation. But with the “resistance” in full swing, bipartisanship may be a pipe dream. On the other hand, if Republicans want to tackle health care alone, they will need to take a different approach from the one that failed in 2017…
There is thus not much to gain by spending 2018 trying to replace ObamaCare’s insurance exchanges. Republicans can instead liberalize the individual insurance market by restoring flexibility that states lost under ObamaCare. A good strategy would be to build on bipartisan efforts such as those from Sens. Lamar Alexander and Patty Murray.” (P)
“So, pulling the individual mandate out of Obamacare does not kill Obamacare. It will probably destabilize it a bit. But destabilizing Obamacare without replacing it is no good. It essentially speeds it up, by driving the country to the point where there is no working insurance sector for individual, non-employer, markets.
A crumbling private insurance sector will not help. Instead, it will legitimize calls for a government takeover of health insurance — the so-called “single-payer” healthcare system…
The question, therefore, is how to overcome the barriers at which repealing and replacing Obamacare fell last year? The answer is to embrace the safety net that Democrats and Sen. Susan Collins, R-Maine, demand, but separate it from the insurance market. Deregulate insurance, delink it from employment, and allow purchases across state lines. Create real competition in healthcare provision and the way it is paid for.
Then, separately, create better government-backed insurance products for those who can’t get affordable insurance in the market. This isn’t a small-government ideal, but it’s better than a single-payer nightmare.” (Q)
“Obamacare isn’t failing. Again.
That report instead finds that the Obamacare market has continued “stabilizing,” and that insurers are “regaining profitability” despite continued political uncertainty over the health-care law.
It also found that the pool of Obamacare customers, while less healthy as a group than before the law took effect, showed no signs of becoming sicker in the latter part of 2017.
“Data suggest that insurers in this market are on track to reach pre-[Affordable Care Act] individual market performance levels,” said the report, prepared by analysts from the Kaiser Family Foundation.
The report, comes on the heels of surprisingly strong enrollment on the federal Obamacare marketplace during the recently concluded open sign-up season.
The Trump administration, which opposes Obamacare, had taken a series of steps that experts believed would markedly depress the number of sign-ups for individual health plans this year.
President Donald Trump also has repeatedly said that Obamacare is “failing,” and needs to be substantially replaced with new health-care legislation.” (R)
“A book detailing the first year of President Trump’s time in office claims he floated the idea of covering all Americans through Medicare and had little interest in repealing Obamacare.
“All things considered, he probably preferred the notion of more people having health insurance than fewer people having it,” Michael Wolff writes in Fire and Fury: Inside the Trump White House. “He was even, when push came to shove, rather more for Obamacare than for repealing Obamacare.”
Trump also reportedly asked his aides aloud, “Why can’t Medicare simply cover everybody?”…
The late Roger Ailes, who was chairman and CEO at Fox News, told Wolff that “no one in the country, or on earth, has given less thought to health insurance than Donald.”” (S)
“As President Trump meets with congressional Republican leaders at Camp David this weekend, he’s going to be faced with tough decisions about his second-year agenda. Here are some items he could consider.
First, end the congressional exemption from ObamaCare. The biggest disappointment of 2017 was the failure of Republicans to fully repeal ObamaCare. It is a huge disgrace, and will likely hurt them as they seek reelection in 2018. The best way to motivate them to repeal this law is to force them to live under the law like every other American, something they haven’t had to face since President Obama ordered an illegal carve-out for members of Congress and their staffs more than four years ago. The best part is that this is something the president doesn’t need to wait for Congress to do. He can do this himself with the stroke of a pen, by simply directing the Office of Personnel Management to overturn its ruling of late 2013 approving members of Congress and their staffs to purchase health insurance through the District of Columbia small business exchange, which allowed them an employer’s subsidy they were not meant to receive.” (T)
“The chances of repealing ObamaCare this year are fading further, with top Republicans saying they hardly discussed repeal of the law during a Camp David retreat last weekend focused on their 2018 agenda….
A source familiar with the conversations at Camp David confirmed that ObamaCare repeal was hardly discussed, except for Senate Majority Leader Mitch McConnell (R-Ky.) saying that he did not want to do a partisan bill like ObamaCare repeal or entitlement reform through the fast-track process of reconciliation this year.
ObamaCare repeal has largely fallen off the GOP agenda for 2018, in part due to the realities of a narrower Senate majority than one that already failed to pass a repeal bill. Reopening the divisive issue in an election year would also be tough.” (U)
“You can scour the rest of the text, but I don’t think you’ll find any other mentions of the individual mandate. Notice at the bottom that the effective date is after this year, so folks still need to have health insurance in 2018 or pay the penalty.
The method by which the mandate was repealed is interesting: they merely zeroed out the penalty for noncompliance. In the ACA, it’s called a penalty, but the Supreme Court ruled it a tax. So the “tax” now has a rate of “zero percent” and a bottom levy of “$0.” But because Obamacare is still on the books, some future Congress under Democrat control could easily raise the tax or penalty back to where it was, or even higher — and use reconciliation to do so!” (V)
(A) 5 actions Trump can take to undermine the ACA in 2018, by Leo Vartorella, https://www.beckershospitalreview.com/hospital-management-administration/5-actions-trump-can-take-to-undermine-the-aca-in-2018.html
(B) Obamacare barely survived 2017. How’s 2018 look?, by BENJY SARLIN, https://www.nbcnews.com/politics/white-house/obamacare-barely-survived-2017-how-s-2018-look-n832936
(C) President Trump Says Republicans and Democrats Will ‘Come Together’ to Replace Obamacare, http://time.com/5079455/trump-obamacare-republicans-democrats/
(D) Transcending politics, Trump’s core supporters love ObamaCare, by EUGENE GU, http://thehill.com/opinion/healthcare/366801-Transcending-politics-Trumps-core-supporters-love-ObamaCare
(E) CRIPPLING OBAMACARE HURTS POOR PEOPLE AND WOMEN ABOVE ALL, by ROBERT WALKER, http://www.newsweek.com/crippling-obamacare-hurts-poor-people-and-women-above-all-758311
(F) Proposed Obamacare Rule Could Weaken Benefits, by Sara Hansard, https://www.bna.com/proposed-obamacare-rule-b73014473614/
(G) Insurers Divvy Up Spoils For Sticking With Obamacare In 2018 by Bruce Japsen , https://www.forbes.com/sites/brucejapsen/2017/12/26/insurers-divvy-up-spoils-for-sticking-with-obamacare-in-2018/#715e8a8b467a
(H) The future of Obamacare now linked to midterm election in 2018, by AMY GOLDSTEIN, http://www.pressherald.com/2017/12/25/aca-future-is-linked-to-midterm-election-in-2018/
(I) Obamacare Will Survive in 2018, by Max Nisen, https://www.bloomberg.com/gadfly/articles/2017-12-27/obamacare-will-survive-in-2018
(J) GOP may have no choice but to try health care again after taxes, by Sam Baker, https://www.axios.com/gop-may-have-no-choice-but-to-try-health-care-again-after-taxes-2513940879.html
(K) A comprehensive bipartisan solution to healthcare reform is probably impossible, by Emily Jashinsky, http://www.washingtonexaminer.com/a-comprehensive-bipartisan-solution-to-healthcare-reform-is-probably-impossible/article/2644412
(L) States can fix Republicans’ Obamacare mess, https://www.washingtonpost.com/opinions/states-can-fix-republicans-obamacare-mess/2018/01/01/19590388-dabb-11e7-b1a8-62589434a581_story.html?utm_term=.c380426f1edb
(M) POLLAK: Republicans Will Lose in 2018 If They Fail to Solve Health Insurance Crisis, by JOEL B. POLLAK, http://www.breitbart.com/big-government/2018/01/02/pollak-republicans-can-win-in-2018-if-they-solve-health-insurance-crisis/
(N) Republicans face a fresh fight over Obamacare: Repeal it or repair it?, by Deirdre Shesgreen, https://www.usatoday.com/story/news/politics/2018/01/02/republicans-face-fresh-fight-over-obamacare-repeal-fix/997008001/
(O) Trump offers new rule going after ObamaCare, by NATHANIEL WEIXEL, http://thehill.com/policy/healthcare/367393-Trump-offers-new-rule-going-after-ObamaCare
(P) Republicans Can’t Avoid ObamaCare in 2018, by Avik Roy, https://www.wsj.com/articles/republicans-cant-avoid-obamacare-in-2018-1514938806
(Q) Happy New Year! Now repeal and replace Obamacare, http://www.washingtonexaminer.com/happy-new-year-now-repeal-and-replace-obamacare/article/2644914
(R) Obamacare insurers see better financial performance in 2017, ‘no sign of market collapse’, by Dan Mangan, https://www.cnbc.com/2018/01/04/obamacare-health-insurers-see-improved-financial-performance-in-2017.html
(S) Michael Wolff: Trump had little interest in repealing Obamacare, floated ‘Medicare for All’, by Kimberly Leonard, http://www.washingtonexaminer.com/michael-wolff-trump-had-little-interest-in-repealing-obamacare-floated-medicare-for-all/article/2645078
(T) A 2018 agenda for President Trump, by JENNY BETH MARTIN, http://thehill.com/opinion/white-house/367793-a-2018-agenda-for-president-trump
(U) ObamaCare repeal fades from GOP priorities list in new year, by PETER SULLIVAN, http://thehill.com/policy/healthcare/368223-obamacare-repeal-fades-from-gop-priorities-list-in-new-year
(V) The Trump Tax Cuts and the Obamacare Mandate ‘Repeal’, by Jon N. Hall, http://www.americanthinker.com/articles/2018/01/1_9_2018_14_3.html#ixzz53pt56pUl