“It leaves us with two laws… Call the first one Obamacare… Call the second one Trumpcare”

“About 8.8 million Americans enrolled in health coverage through Healthcare.gov, the Trump administration announced Thursday, a slight dip from last year after the Trump administration cut spending and outreach but far from a dramatic drop.
Last year, about 9.2 million people signed up through Healthcare.gov, which serves more than 30 states. A dozen states run their own marketplaces and several of those states have not yet closed their open enrollment.
Seema Verma, the head of the Centers for Medicare and Medicaid Services, which oversees the federal marketplace, tweeted next year’s Obamacare enrollment numbers a week after the open enrollment period for 2018 coverage ended.
There are two ways to look at the numbers: On the one hand, in a thriving marketplace, you would expect enrollment to grow every year. On the other hand, given the deep cuts that the Trump administration made to Obamacare advertising and the decision to have the sign-up window, the law has proven pretty resilient.” (A)

“The numbers essentially defied President Trump’s assertion that “Obamacare is imploding.” They suggested that consumers want and need the coverage and subsidies available under the Affordable Care Act, even though political battles over the law, President Barack Obama’s signature domestic achievement, are sure to continue in Congress and in next year’s midterm election campaigns.
Seema Verma, the administrator of the federal Centers for Medicare and Medicaid Services, reported the total in a Twitter post on Thursday. She said her agency had done a great job to “make this the smoothest experience for consumers to date.”
Republican efforts to dismantle the Affordable Care Act this year had an unintended effect: They heightened public awareness of the law and, according to opinion polls, galvanized support for it among consumers who feared that it might be taken away….
Ms. Verma tried over the summer to persuade Congress to repeal the Affordable Care Act, but on Thursday, she boasted about how well the law’s insurance marketplace — under new management — was meeting the needs of consumers.” (B)

“After Trump signs the tax bill into law, enrollment could drop precipitously now that people are not financially pressured to buy health insurance. Health policy experts predict a sizable number of healthy people likely won’t enroll.
That could two do things, say health-care experts: Drive enrollment down further and raise premiums even higher, since insurance companies will be spending more money on sick people without balancing it with healthy people.
That means that in places where there aren’t wide swaths of insured Americans — such as rural areas in Iowa or New Hampshire — insurance companies could have incentive to pull out of Obamacare exchanges, further weakening the law. In a sense, Republicans are creating a self-fulfilling prophecy.
Some health experts warn it could be a prophecy Republicans could come to regret, since residents of less-populated areas and the self-employed, who are also often uninsured, tend to be Republican.” (C)

“Senate Majority Leader Mitch McConnell on Thursday said he wants the Senate to move past Obamacare repeal in 2018 in favor of stabilizing insurance markets and to other issues, prompting a backlash from one of the Senate’s most prominent advocates of repeal and an ally of President Trump….
“Well, we obviously were unable to completely repeal and replace with a 52-48 Senate,” McConnell said referring to the partisan split in the chamber. “We’ll have to take a look at what that looks like with a 51-49 Senate [once Alabama Democratic Sen.-elect Doug Jones is seated]. But I think we’ll probably move on to other issues.”
McConnell’s comment drew a sharp rebuke from Sen. Lindsey Graham (R-S.C.), who is hoping to revive a bill next year repealing Obamacare in favor of block grants to states. He and Sen. Bill Cassidy – who authored the last GOP attempt to repeal the health care law in 2017 – met this week to strategize about how to bring back the effort in the new year.
“I think that’s a huge mistake,” Graham told reporters. “We should do everything we can to replace it, as much as [Democrats] did to pass it. We own it now.”” (D)

“Republican Sen. Lindsey Graham of South Carolina immediately pushed back on McConnell’s comments. “To those who believe — including Senate Republican leadership — that in 2018 there will not be another effort to Repeal and Replace Obamacare — you are sadly mistaken,” Graham said in a statement and on Twitter.
Obamacare is still the law of the land and will continue to crumble which will drive up insurance costs for hard-working Americans and eventually pave the path to single-payer health care.
I’m fully committed to Repealing and Replacing Obamacare in 2018 by block-granting the money back to the states and away from Washington bureaucrats who are completely unaccountable to the patients of America.”” (E)

“With President Donald Trump poised to sign a tax bill that would effectively kill off the mandate requiring most Americans to buy health insurance coverage or pay a fine, calls for federal legislation to stabilize the individual insurance market are intensifying. But some experts doubt that federal help for 2018 is on the way, and wonder if states would be better off taking action on their own to prop up their markets….
States may be better able to keep their individual markets afloat by taking matters into their own hands. States could implement their own individual mandate penalties. Massachusetts has had one for the past 10 years. However, implementing the ACA’s most unpopular provision would be politically tricky. Officials in states including California, Connecticut, Maryland and others are considering their own mandates.
States could also set up state-based reinsurance programs and apply for federal funding under a 1332 waiver. Alaska, Minnesota and Oregon have lowered premiums in their marketplaces by taking that route. Most states don’t have enough money to run a reinsurance program independently… (F)

“In practice, the precise effect of the provision has been unclear. The Obama administration had made the mandate somewhat porous, with a long list of life circumstances that would exempt people from having to pay a penalty. Some economists have argued that the penalties are too small to encourage the truly reluctant to enroll. The C.B.O. said it was re-evaluating its own assumption but thought it had probably overestimated the provision’s impact on premiums and insurance enrollment. Still, some mandate enthusiasts continue to argue that the provision’s disappearance will lead to a death spiral of ever-escalating insurance premiums and eventual market collapses.
Those questions, once largely academic, will get real-life answers in coming months and years. The end of the mandate will establish a sort of natural experiment, in which its influence will become much more clear. Some states may not wait to find out. Policymakers in several blue states are weighing state-level insurance mandates. Those policy descendants may help settle the question of the importance of the mandate to the design of Obamacare, with its market-based system for expanding insurance coverage.” (G)

“While young and healthy individuals may very well rejoice at the repeal of the individual mandate, nobody stays young and healthy forever. Just as Social Security relies upon a younger generation of workers to fund the retirement income of the elderly, so too does ObamaCare rely on the healthy to take care of the sick. We all eventually retire and we all eventually get sick. It is just a basic fact of life that every single one of us will have our time of need.
But now Republicans are appealing to our selfish, short-term instincts to make us lose sight of our long-term future as a nation. Throughout all the ObamaCare repeal attempts, from the skinny repeal to Graham-Cassidy bill to the elimination of cost share reductions, Republicans have tried so hard in so many ways to make America sick again. This time they may have very well succeeded.” (H)

“A new poll by The Associated Press-NORC Center for Public Affairs Research finds that 48 percent named health care as a top problem for the government to focus on in the next year, up 17 points in the past two years.
The poll allows Americans to name up to five priorities and found a wide range of top concerns, including taxes, immigration, and the environment. But aside from health care, no single issue was named by more than 31 percent.
And 7 in 10 of those who named health care as a top problem said they had little to no confidence that government can improve matters. The public was less pessimistic in last year’s edition of the poll, when just over half said they lacked confidence in the problem-solving ability of lawmakers and government institutions.” (I)

“First, the just-passed Republican tax plan eliminates the penalty on people who don’t have ACA-approved health coverage. So people will soon be able to buy short-term insurance without worrying about that penalty….
But short-term plans don’t have to meet standards set by the ACA, so they often come with limitations that can leave people with huge medical bills if they get seriously ill. These plans can be cheap,…“but they also don’t cover very much.”
For example, insurers can exclude coverage or charge extra for everything from maternity care and prescription drugs to mental health care. They also don’t have to cover pre-existing conditions—that is, any condition for which you have experienced symptoms or sought treatment for up to five years before enrolling. And if you get seriously ill after the policy starts, the company can refuse to later renew your plan.
Short-term plans can also have higher deductibles than what’s allowed by the ACA…. By contrast, ACA plans are prevented by law from putting a dollar limit on any of these essential health benefits.” (J)

“Take, for example, the poor Maine Warden Service pilot who landed Wednesday morning on Eagle Lake in northern Maine. While taxiing to the state’s airplane base, he hit a soft spot and, well, all you can see now is the Cessna’s tail poking through a hole in the surface.
Which brings us to Sen. Susan Collins. “I’m not pretending that I’m not disappointed and annoyed,” Maine’s senior senator said in a telephone interview late Wednesday, shortly after her much-ballyhooed bargain with Senate Majority Leader Mitch McConnell sank like a plane on thin ice.
The deal went like this: In exchange for Collins’ vote for the Republicans’ tax giveaway to corporations and the wealthiest among us, McConnell promised – promised – that two bipartisan bills aimed at rescuing the Affordable Care Act, or Obamacare, would pass by the end of the year.
Wednesday afternoon, while President Trump and a herd of happy Republicans gathered at the White House to bask in the glow of their newly minted tax “reform,” Collins and Sen. Lamar Alexander, R-Tennessee, announced that, alas, their two Obamacare bills will have to wait until next year.
Deadline? What deadline? Promise? What promise?..
She blamed Senate Minority Leader Chuck Schumer, D-New York, who announced last week that Democrats in the Senate would not support the Obamacare rescue legislation as part of a year-end stopgap spending bill.
If that’s not a warning sign of danger ahead, what is?…
Little wonder that much of Washington, D.C., not to mention Maine, now snickers about how Collins got played. “If I get the bills that I’ve been advocating for passed, but they’re passed six to eight weeks later than I expected, how does that mean I’ve been played?” she asked. “How do you know you’re going to get them in six to eight weeks?” I countered. “How do you know I’m not?” she replied. I don’t.
But like most common-sense Mainers, I know enough to stay off thin ice.” (K)

“In a larger sense, the Republicans’ rhetorical victory of cutting out the individual mandate will make the ACA — which is increasingly popular — even more popular. The individual mandate was the only aspect of the law that didn’t enjoy wide support among the public. The other components of the law — protecting preexisting conditions, ending lifetime caps, ensuring that certain benefits such as chemotherapy and mental health are covered by law — enjoy widespread popularity.
A more popular law will be a more challenging target to repeal. And already Senate Majority Leader Mitch McConnell (R-Ky.), with an even narrower majority after the Alabama Senate race, is signaling that repeal may be a bridge too far.
So where does this leave us? It leaves us with two laws.
Call the first one Obamacare. It provides preexisting condition protections and other safeguards to American families. And for the millions covered under the Medicaid expansion or who have family incomes less than $100,000, it delivers affordable health-care coverage.
Call the second one Trumpcare. It exposes many — especially in rural areas and those who make too much for subsidies — to significantly increasing premiums, driven by the calculated decision from Republicans to get rid of the mandate.” (L)

(A) 8.8 million people signed up for Obamacare coverage despite Trump’s sabotage, by Dylan Scott, https://www.vox.com/policy-and-politics/2017/12/21/16807348/obamacare-enrollment-2018
(B) Obamacare Sign-ups at High Levels Despite Trump Saying It’s ‘Imploding’, by ROBERT PEAR, https://www.nytimes.com/2017/12/21/us/politics/health-obama-care-affordable-care-act.html?_r=0
(C) No, Trump didn’t repeal Obamacare. But he may regret claiming as much, by Amber Phillips, https://www.washingtonpost.com/news/the-fix/wp/2017/12/21/no-trump-didnt-repeal-obamacare-but-he-may-regret-claiming-as-much/?utm_term=.0f6897582a8e
(D) McConnell: ‘We’ll probably move on’ from Obamacare repeal in 2018, by CRISTIANO LIMA and JENNIFER HABERKORN, https://www.politico.com/story/2017/12/21/mcconnell-well-probably-move-on-from-obamacare-312407
(E) McConnell Ready To ‘Move On’ From Obamacare Repeal, Others In GOP Say Not So Fast, by KELSEY SNELL, https://www.npr.org/2017/12/21/572588692/mcconnell-wants-bipartisanship-in-2018-on-entitlements-immigration-and-more
(F) Calls for Obamacare market stabilization intensify as individual mandate penalty is axed, by Shelby Livingston, http://www.modernhealthcare.com/article/20171221/NEWS/171229980
(G) Requiem for the Individual Mandate, by Margot Sanger-Katz, https://www.nytimes.com/2017/12/21/upshot/individual-health-insurance-mandate-end-impact.html
(H) Repeal of the ObamaCare mandate is a selfish and short-term plan, by DR. EUGENE GU, http://thehill.com/opinion/healthcare/366046-repeal-of-the-obamacare-mandate-is-a-selfish-and-short-term-plan
(I) Poll says US citizens worry most about health care, by Emily Swanson and Ricardo Alsonso-Zaldivar, https://www.csmonitor.com/USA/2017/1221/Poll-says-US-citizens-worry-most-about-health-care
(J) Is ‘Short-Term’ Health Insurance a Good Deal?, by Nancy Metcalf, https://www.consumerreports.org/health-insurance/is-short-term-health-insurance-a-good-deal/
(K) With raised ax in plain sight, Collins went out on a limb, by Bill Nemitz, http://www.pressherald.com/2017/12/22/bill-nemitz-with-raised-ax-in-plain-sight-collins-went-out-on-a-limb/
(L) Republicans didn’t repeal Obamacare. They solidified it, by Andy Slavitt, https://www.washingtonpost.com/opinions/republicans-didnt-repeal-obamacare-they-solidified-it/2017/12/22/c2eec7e2-e72d-11e7-a65d-1ac0fd7f097e_story.html?utm_term=.ab60c9066378