Trump told a GOP senator she could only ride on Air Force One if she voted for the healthcare bill. *

“At no point during the campaign or since the inauguration has Trump articulated any kind of clear vision for how to improve health care. There is no unifying theme around his pronouncements, such as the promotion of a market-driven system. Instead, he makes vague statements about how the ACA is a disaster, without specifying with facts what he means with his criticisms, and then promises that he will deliver a better plan without describing in any way exactly how he will do it….
Instead of pushing McConnell to pass whatever can get 50 Republican votes in the Senate, Trump and his aides should regroup and do the hard work that should have been done months and even years ago to come up with a more plausible approach to health reform. The goal should be to develop a plan built more on market principles than on government control and regulation, and which can garner support from most Republicans, and some Democrats too. Such a plan would necessarily be more incremental than a plan written just by GOP members, and it would roll back less of the ACA than many Republicans would like to see occur. But it would also be far less controversial than the various versions of repeal and replace that have been assembled so far this year, and thus also more likely to survive when political control inevitably shifts again…. (A)

“Don’t tell President Trump, but cutting off extra Obamacare subsidies to insurers could actually improve – not ignite – the very insurance marketplaces he wants to undermine.
Weirdly enough, slightly more people – not fewer — could receive health insurance by 2020 were the president to terminate the controversial cost-sharing payments, otherwise known as CSRs, which compensate insurers for discounts they must offer their lowest-income customers.
That’s the rather unconventional conclusion the Congressional Budget Office came to last week after analyzing the effect on the Obamacare marketplaces should the president eliminate the monthly subsidy payments, as he’s repeatedly threatened to do over the past few weeks (to the chagrin of some Republicans in Congress). And perhaps this is one CBO report that the Trump administration could like. (B)

“When Senator Robert Menendez of New Jersey goes on trial on federal corruption charges in less than three weeks, far more than his own fate hinges on the outcome.
If Mr. Menendez, a Democrat, is convicted and then expelled from the United States Senate by early January, his replacement would be picked by Gov. Chris Christie, the Republican governor of New Jersey and an ally of President Trump.
That scenario — where Mr. Menendez’s interim replacement would more than likely be a Republican — would have immediate and far-reaching implications: The Republicans would be gifted a crucial extra vote just as the party remains a single vote shy in the Senate of advancing its bill to dismantle President Obama’s signature health care law. Those potential consequences only heighten the drama around the first federal bribery charges leveled against a sitting senator in a generation. (C)

“Unlike the double-digit percentage rate hikes individuals purchasing coverage under the Affordable Care Act will see next year, those with coverage at large employers will face single-digit increases, a new national survey of large employers shows….
Large employers face 5% health care cost increases for 2018, according to the National Business Group on Health annual Health Care Strategy and Plan Design Survey.
Though employer and worker premiums are still rising two to three times the rate of general inflation, the percentage increase won’t come close to the premium increases Americans are expected to face should they seek ACA-compliant coverage this fall for 2018. ACA-compliant Obamacare plans are submitting rate hikes of 25% or higher thanks in part to the Donald Trump White House’s inability to commit to signing off on cost-sharing reductions for low-income purchasers of subsidized Obamacare policies.
Employers say they are thankfully immune from the issues plaguing the ACA’s unstable individual market and its risk pools of sick patients whose costs far outweigh the number of healthy Americans signing up. To pay sick patient claims, premiums are jumping dramatically in the individual market.
But the employer market has remained stable.” (D)

“…Before I go into details, here are some bullet points of my findings.
For a broad spectrum of middle-aged persons in the middle class, premiums for even the cheapest bronze policy today are, in a majority of rating areas examined, so expensive that people are formally exempt from the individual mandate.
For people age 60 and earning about 450% of the federal poverty level, premiums today for the second lowest silver plan are unaffordable in a majority of rating areas studied. This is true using both metrics employed here to determine affordability.
In 2018, assuming premiums rise 20% as is frequently forecast, the situation becomes much worse for the middled-aged, middle class. Among persons age 50 and earning 500% of the federal poverty level, for example, people will be exempt from the individual mandate in 73% of rating areas studied. This is so because even the cheapest bronze policy will cost more than 8% of their income. And in about 30% of the rating areas, prices for the second lowest silver plan will be so high, that persons of this age and income will have to pay more than 1.5 times the amount they would have been required to pay for the same policy if they received even the smallest subsidy from the federal government. (E)

“Most enrollees in the marketplaces (84%) receive a tax credit to lower their premium and these enrollees will be protected from premium increases, though they may need to switch plans in order to take full advantage of the tax credit. The premium tax credit caps how much a person or family must spend on the benchmark plan in their area at a certain percentage of their income. For this reason, in 2017, a single adult making $30,000 per year would pay about $207 per month for the second-lowest-silver plan, regardless of the sticker price (unless their unsubsidized premium was less than $207 per month). If this person enrolls in the second lowest-cost silver plan is in 2018 as well, he or she will pay slightly less (the after-tax credit payment for a similar person in 2018 will be $201 per month, or a decrease of 2.9%). Enrollees can use their tax credits in any marketplace plan. So, because tax credits rise with the increase in benchmark premiums, enrollees are cushioned from the effect of premium hikes. (F)

“Senate Majority Leader Mitch McConnell (R-Ky.) acknowledged Monday that Congress’s next steps on healthcare are unclear after Republicans failed to repeal ObamaCare….
McConnell added that lawmakers were “going to see” what negotiations between Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), the top two members of the Senate’s healthcare committee, aimed at stabilizing the individual health insurance market could produce.
“We have … collapsing individual insurance markets around the country. Requests to continue to subsidize the insurance companies. It’s a pretty controversial subject to subsidize insurance companies without any reforms,” the GOP senator said.
He added that Democrats “have been pretty uninterested in any reforms,” but the two parties will need to try to negotiate when they get back to Washington next month.
“So when we get back after Labor Day we’ll have to sit down and talk to them and see … what the way forward might be,” he said.” (G)

“The Senate health committee will hold two hearings early next month on how the nation’s individual health insurance marketplaces can be stabilized, as party leaders grasp for a fresh path following the collapse of the Republican effort to repeal and replace much of former President Barack Obama’s health care law.
GOP and Democratic leaders are exploring whether they can craft a bipartisan but limited bill aimed at curbing rising premiums for people who buy their own insurance. In many markets, consumers are seeing steeply rising premiums and fewer insurers willing to sell policies.” (H)

“Democrats are ready to go on the health care offensive. And Sen. Brian Schatz (D-HI) may have a new plan for them to do it.
In an interview with Vox, Schatz revealed that he’s preparing a new bill that could grant more Americans the opportunity to enroll in Medicaid by giving states the option to offer a “buy-in” to the government program on Obamacare’s exchanges.
His proposal would expand the public health insurance program from one that covers only low-income Americans to one open to anyone seeking coverage, depending on what each state does. The idea is similar to the government-run “public option” that some Democrats advocated for during the battle over the Affordable Care Act’s passage.” (I)

The new (Republican) concept, sponsored by Senators Bill Cassidy and Lindsey Graham, would redirect current Obamacare spending to the states, giving each state legislature significant flexibility in how the dollars are spent, so long as it’s on healthcare.
The bill is an amendment to the Senate’s initial repeal bill, the Better Care Reconciliation Act, and it would also repeal the employer and individual mandates, but keep the rule requiring insurers to cover pre-existing conditions. It would cut subsidies and Medicaid expansion and direct the money to the states to use as they see fit.
Cassidy, a physician, says the plan returns power to the states. But the amendment wouldn’t necessarily benefit each state equally. Funding equations would be based on poverty, density and income, and as with any healthcare policy, some consumers would likely benefit from the Cassidy/Graham plan, and others would be worse off. (J)

“The relationship between President Trump and Senator Mitch McConnell, the majority leader, has disintegrated to the point that they have not spoken to each other in weeks, and Mr. McConnell has privately expressed uncertainty that Mr. Trump will be able to salvage his administration after a series of summer crises.” (K)


(A) Trump deserves much of the blame on health care, by James C. Capretta,
(B) The Health 202: Trump’s plan to harm Obamacare would actually help it, by Paige Winfield Cunningham,
(C) At Senator Menendez’s Trial, Stakes Are High for Democrats, by By SHANE GOLDMACHER,
(D) Employers Will Escape Obamacare-Sized Rate Hikes In 2018, by Bruce Japsen ,
(E) New Research Shows Many In Middle-Aged, Middle Class Can’t Afford ACA Policies in 2018, by Seth Chandler Seth Chandler,
(F) An Early Look at 2018 Premium Changes and Insurer Participation on ACA Exchanges, by Rabah Kamal, Cynthia Cox, Care Shoaibi, Brian Kaplun, Ashley Semanskee, and Larry Levitt,
(G) McConnell: Path on healthcare ‘murky’, by JORDAIN CARNEY,
(H) Senate panel plans 2 hearings on girding health insurance, by ALAN FRAM,
(I) Exclusive: Sen. Schatz’s new health care idea could be the Democratic Party’s future, updated by Sarah Kliff and Jeff Stein,
(J) New Obamacare Repeal Bill Returns Power to States, But Will It Pass?, by Alex Tolbert,
(K) McConnell, in Private, Doubts if Trump Can Save Presidency, by ALEXANDER BURNS and JONATHAN MARTIN,