ACA | Affordable Care Act | PPACA | Patient Protection and Affordable Care Act | Obamacare | Repeal and Replace

The Affordable Care Act (Obamacare) was designed so that all plans purchased in the Marketplace (ACA exchanges) cover a base set of essential health benefits (EHB) which consist of the following:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren't essential health benefits)
  • Birth control coverage
  • Breastfeeding coverage

Source:

"What Marketplace health insurance plans cover". healthcare.gov. Retrieved 2017-03-24.

View all of the U.S. Department of Health & Human Services news releases for 2017 here.

Jul 26, 2022:

https://www.politico.com/news/2022/07/26/texas-obamacare-std-hiv-00047724

Jun 17, 2021:

https://thehill.com/regulation/court-battles/558916-supreme-court-upholds-obamacare-in-7-2-ruling

Nov 10, 2020:

https://www.pbs.org/newshour/show/why-the-affordable-care-act-is-back-before-the-supreme-court-amid-a-pandemic
https://www.cnn.com/2020/11/10/politics/supreme-court-obamacare-oral-arguments/index.html
https://www.supremecourt.gov/oral_arguments/argument_transcripts/2020/19-840_i426.pdf

Oct 14, 2020:

https://thehill.com/policy/healthcare/520918-republicans-high-court-wont-toss-obamacare
https://thehill.com/homenews/senate/520981-senators-press-barrett-on-if-obamacare-can-survive-mandate-being-struck-down

Dec 18, 2019:

https://thehill.com/policy/healthcare/475186-appeals-court-strikes-obamacare-mandate-sends-case-back-to-lower-court

Dec 15, 2018:

https://thehill.com/policy/healthcare/421541-five-takeaways-from-the-court-decision-striking-down-obamacare
https://www.vox.com/policy-and-politics/2018/12/14/18141670/obamacare-unconstitutional-texas-judge-strikes-down-reed-o-connor
https://thehill.com/homenews/administration/421546-trump-celebrates-judges-decision-tossing-core-tenets-of-obamacare

Dec 14, 2018:

https://thehill.com/policy/healthcare/421511-federal-judge-in-texas-strikes-down-obamacare

Aug 30, 2018:

http://thehill.com/homenews/senate/404089-gop-eyes-another-shot-at-obamacare-repeal-after-mccains-death

Jan 10, 2018:

https://www.politico.com/story/2018/01/10/trump-obamacare-secret-plan-278145

Dec 20, 2017:

http://thehill.com/policy/healthcare/365185-final-gop-tax-bill-repeals-obamacare-mandate
https://www.nbcnews.com/health/health-care/tax-bill-kills-health-insurance-mandate-who-will-pay-more-n829846

Oct 23, 2017:

http://thehill.com/policy/healthcare/356750-second-republican-state-withdraws-obamacare-waiver-aimed-at-helping
http://thehill.com/opinion/white-house/356624-juan-williams-trumps-cynical-sabotage-of-obamacare

Oct 12, 2017:

Trump issued an executive order entitled "Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States". Here are point-by-point excerpts of the order:

Section 1. Policy. (a) It shall be the policy of the executive branch, to the extent consistent with law, to facilitate the purchase of insurance across State lines and the development and operation of a healthcare system that provides high-quality care at affordable prices for the American people.

Sec. 2. Expanded Access to Association Health Plans. Within 60 days of the date of this order, the Secretary of Labor shall consider proposing regulations or revising guidance, consistent with law, to expand access to health coverage by allowing more employers to form AHPs.

Sec. 3. Expanded Availability of Short-Term, Limited‑Duration Insurance. Within 60 days of the date of this order, the Secretaries of the Treasury, Labor, and Health and Human Services shall consider proposing regulations or revising guidance, consistent with law, to expand the availability of STLDI.

Sec. 4. Expanded Availability and Permitted Use of Health Reimbursement Arrangements. Within 120 days of the date of this order, the Secretaries of the Treasury, Labor, and Health and Human Services shall consider proposing regulations or revising guidance, to the extent permitted by law and supported by sound policy, to increase the usability of HRAs, to expand employers' ability to offer HRAs to their employees, and to allow HRAs to be used in conjunction with nongroup coverage.

Sec. 6. Reports. Within 180 days of the date of this order, and every 2 years thereafter, the Secretary of Health and Human Services, in consultation with the Secretaries of the Treasury and Labor and the Federal Trade Commission, shall provide a report to the President...

Sec. 7. General Provisions.

Trump also announced he is ending Obamacare's cost-sharing reduction payments. Those payments are paid to insurance companies so they can offer lower out-of-pocket costs such as deductibles and co-pays to millions of lower-income people who have health insurance under Obamacare.

The New York Times published a list of eleven things Trump has done to weaken and undermine Obamacare:

  • Opened the door for sales of less expensive plans with fewer benefits and fewer protections for consumers. Signed executive order on Oct. 12.
  • Decided not to send health department officials to local open enrollment events in states. First reported on Sept. 27.
  • Decided to shut down the Affordable Care Act website for 12 hours nearly every Sunday during open enrollment. First reported in September.
  • Said it would cut by 40 percent funding to groups that help people enroll. Announced on Aug. 31.
  • Said it would slash spending on advertising and promotion for enrollment to $10 million from $100 million. Announced on Aug. 31.
  • Made videos criticizing the health law and posted them on YouTube. In June and July.
  • Posted infographics criticizing the health law on Twitter. Mostly in late June and mid-July.
  • Made tax credits for premiums less generous. Finalized in April.
  • Used news releases to spread negative information about the law. As early as February.
  • Weakened enforcement of the individual mandate. Reported in February.
  • Removed useful guidance for consumers about the law from its website. As early as Jan. 20.

Source:

Park, Haeyoun. (October 12, 2017). "We're Tracking the Ways Trump Is Scaling Back Obamacare. Here Are 11.". The New York Times. Retrieved 2017-10-12.

Oct 9, 2017:

http://www.businessinsider.com/trump-obamacare-health-care-repeal-replace-2017-10

Sep 26, 2017:

http://thehill.com/policy/healthcare/352503-senate-wont-vote-on-obamacare-repeal-bill

Sep 25, 2017:

http://time.com/4952807/republican-health-bill-lisa-murkowski/
http://thehill.com/homenews/senate/352300-revised-obamacare-repeal-bill-aims-benefits-at-alaska
http://thehill.com/policy/healthcare/352342-third-gop-senator-opposes-new-obamacare-repeal-killing-bill-ahead-of
http://thehill.com/policy/healthcare/352341-cbo-finds-millions-uninsured-from-repeal-bill

Sep 24, 2017:

http://thehill.com/news-by-subject/healthcare/352187-gop-changes-graham-cassidy-bill-to-win-over-senators-wary-of-the

Sep 23, 2017:

http://thehill.com/policy/healthcare/352086-trump-slams-democrats-mccain-over-health-care-bill

Sep 22, 2017:

http://thehill.com/homenews/senate/351831-graham-and-cassidy-go-into-overdrive-to-win-murkowski-vote
http://thehill.com/policy/healthcare/351931-mccain-to-vote-no-on-obamacare-repeal
http://thehill.com/homenews/administration/352011-trump-on-obamacare-repeal-were-going-to-do-it-eventually
http://thehill.com/policy/healthcare/351912-study-new-repeal-bill-would-leave-21-million-more-without-insurance

Sep 21, 2017:

https://www.nytimes.com/2017/09/21/upshot/the-gop-bill-forces-states-to-build-health-systems-from-scratch-thats-hard.html
http://thehill.com/policy/healthcare/351846-medicaid-directors-warn-repeal-bill-would-be-largest-transfer-of-financial
http://thehill.com/policy/healthcare/351805-which-states-could-win-and-lose-from-the-new-obamacare-repeal-bill
http://thehill.com/policy/healthcare/351598-who-is-for-and-against-the-senate-obamacare-repeal-bill

Sep 20, 2017:

http://www.pbs.org/newshour/rundown/whats-new-gop-health-care-bill-one-simple-chart/
http://thehill.com/policy/healthcare/351593-collins-disappointing-that-bipartisan-health-care-effort-was-halted

Sep 19, 2017:

http://thehill.com/homenews/senate/351464-gop-odds-rise-on-obamacare-repeal
http://thehill.com/policy/healthcare/351341-the-hills-whip-list-republicans-try-again-on-obamacare-repeal
http://thehill.com/policy/healthcare/351362-trump-pence-working-the-phones-for-obamacare-repeal-bill

Sep 13, 2017:

Sep 12, 2017:

Sep 11, 2017:

Aug 31, 2017:

http://thehill.com/policy/healthcare/348763-trump-administration-to-slash-obamacare-outreach-funding

Aug 15, 2017:

Aug 13, 2017:

Aug 1, 2017:

http://thehill.com/policy/healthcare/344883-gop-chairman-opens-door-to-democrats-on-obamacare

Jul 31, 2017:

http://thehill.com/blogs/pundits-blog/healthcare/344638-the-gop-repeal-effort-is-dead-time-to-fix-obamacare-not-kill-it

Jul 29, 2017:

http://thehill.com/homenews/administration/344397-dems-pivot-to-offering-obamacare-improvements
http://thehill.com/homenews/administration/344463-trump-threatens-to-end-csr-payments-if-healthcare-reform-isnt-passed
http://thehill.com/policy/healthcare/344474-schumer-blasts-trump-over-suggestion-administration-wont-make-key-obamacare
https://www.bloomberg.com/news/articles/2017-07-29/trump-hints-at-killing-subsidy-that-gives-health-care-to-poor

Jul 28, 2017:

http://thehill.com/blogs/blog-briefing-room/news/344276-mccain-explains-why-he-voted-to-kill-obamacare-skinny-repeal
http://thehill.com/policy/healthcare/344275-huckabee-calls-for-repeal-of-17th-amendment-after-healthcare-failure
https://www.washingtonpost.com/blogs/plum-line/wp/2017/07/28/now-that-trumpcare-has-failed-its-time-to-drop-all-the-lies/
https://www.nytimes.com/2017/07/28/us/politics/republicans-health-care-legislation-gridlock.html

In an early morning vote of 49-51, the U.S. Senate voted against the "skinny repeal" of Obamacare bill. Republican Senators John McCain (Arizona), Susan Collins (Maine), and Lisa Murkowski (Alaska) all voted "no".

Commentary:

The average salary of a U.S. Congressman is $174,000. How much time, energy, and money did Republicans in the House and Senate spend over the past six months on their attempt to repeal and replace Obamacare? Imagine if all of that time and energy had been spent on working with Democrats to fix Obamacare instead. Each and every American citizen should be appalled and outraged by this incredible waste of time and money by the GOP.

Maybe now Republicans will finally sit down with Democrats and come up with a real, better plan for the health care of all Americans.

Jul 27, 2017:

http://thehill.com/homenews/senate/344156-democrats-reject-gop-single-payer-amendment
http://thehill.com/policy/healthcare/344133-senate-republicans-plan-to-defund-planned-parenthood-in-skinny-repeal
http://thehill.com/policy/healthcare/344139-parliamentarian-issues-warning-on-another-gop-healthcare-proposal
http://thehill.com/policy/344225-four-gop-senators-threaten-to-block-skinny-repeal
http://www.reuters.com/article/us-usa-healthcare-idUSKBN1AC1G0
http://thehill.com/policy/healthcare/344262-american-medical-association-calls-skinny-obamacare-repeal-bill-a-toxic
http://thehill.com/policy/healthcare/344254-two-gop-senators-say-ryans-assurance-on-a-healthcare-bill-is-insufficient

Jul 26, 2017:

By a vote of 55-45, the U.S. Senate voted against an amendment from Senator Rand Paul (Republican-Kentucky) to repeal Obamacare and give Congress two years to approve a replacement.

Seven GOP Senators - Lamar Alexander (Tennessee), Shelley Moore Capito (West Virginia.), Susan Collins (Maine), Dean Heller (Nevada.), John McCain (Arizona), Lisa Murkowski (Alaska), and Rob Portman (Ohio) - and all 48 Democrats voted against the amendment.

Jul 25, 2017:

By a vote of 51-50, the U.S. Senate approved the opening of debate on health care legislation. Arizona GOP Senator John McCain appeared on the Senate floor to cast his "yes" vote, just 10 days after undergoing surgery for a blood clot. Senator Lisa Murkowski (Republican-Alaska) and Susan Collins (Republican-Maine) both voted "no". Vice President Mike Pence cast the tie-breaking vote.

Senate Majority Leader Mitch McConnell presented his own health-care proposal, requiring 60 votes for passage, which was voted on and defeated 43-57.

Jul 21, 2017:

http://thehill.com/policy/healthcare/343234-parliamentarian-deals-setback-to-gop-healthcare-bill

Jul 20, 2017:

http://www.thedailybeast.com/team-trump-used-obamacare-money-to-run-ads-against-it
http://thehill.com/blogs/floor-action/senate/342981-rand-paul-opens-door-to-backing-healthcare-bill-on-key-hurdle
http://thehill.com/policy/healthcare/342941-cbo-22-million-would-lose-coverage-under-senate-obamacare-replacement

Jul 19, 2017:

Late yesterday, Mitch McConnell said the following:

For the information of all senators, at the request of the President [Trump] and Vice President [Pence] and after consulting with our members, we will have the vote on the motion to proceed to the ObamaCare repeal bill early next week.

Apparently, the Senate plans to vote on the Obamacare replacement bill already passed by the House, with an amendment to repeal.

Source:

Carney, Jordain. (July 18, 2017). "McConnell: Senate to try to repeal ObamaCare next week". The Hill. Retrieved 2017-07-18.

http://thehill.com/blogs/floor-action/house/342807-freedom-caucus-to-try-to-force-obamacare-repeal-vote
http://thehill.com/policy/healthcare/342804-cbo-obamacare-repeal-without-replace-would-cost-32-million-insurance
http://thehill.com/blogs/blog-briefing-room/news/342841-capitol-police-arrest-155-people-at-healthcare-demonstrations

Jul 18, 2017:

GOP Senator Lisa Murkowski (Alaska) said she does not support McConnell's idea to repeal Obamacare now and replace it later, which means there are not enough votes to pass a bill for replacement now. Murkowski said:

To just say repeal and 'Trust us, we're going to fix it in a couple of years,' that's not going to provide comfort to the anxiety that a lot of Alaskan families are feeling right now.

Trump said the following:

I think we're probably in that position where we'll just let Obamacare fail. We're not going to own it. I'm not going to own it. I can tell you that the Republicans are not going to own it. We'll let Obamacare fail and then the Democrats are going to come to us and they're going to say, 'How do we fix it?'

Source:

Werner, Erica (Associated Press); Fram, Alan (Associated Press). (July 18, 2017). "'Let Obamacare fail,' Trump declares as GOP plan collapses". ABC News. Retrieved 2017-07-18.

Senate Majority Leader Mitch McConnell (Republican-Kentucky) said he will make another attempt to repeal Obamacare in the near future.

Read an op-ed entitled "OPINION | GOP's 7-year ObamaCare blood oath ends in failure" written by contributor Maria T. Cardona on The Hill website here.

Commentary:

So, after almost six months of a Republican effort to pass legislation to repeal and replace Obamacare, the effort has stalled in the Senate. And, thanks to reasonable, level-headed thinkers like Alaska Senator Lisa Murkowski, Republicans won't be able (at least for the moment) to make a ridiculous attempt to repeal now and replace later. The idea of repeal now, with no viable replacement, is absurd and dangerous. The fact that Republicans would even consider this option shows how bad they want to get rid of Obamacare, regardless of the consequences.

Trump's comment about just letting Obamacare fail is ill-advised. The American people are listening, in particular Independents, who most likely will be the decisive factor in the 2018 mid-term elections. Whether Trump and Republicans like it or not, letting Obamacare fail would reflect just as much on them as it would on Democrats. Republicans have control of Congress and the Presidency, and still, because they can't even agree among themselves, they can't pass a bill.

Maybe now, what should have happened six months ago, will finally happen - Democrats and Republicans sitting down and hashing out a bill to fix Obamacare. This would be an incredibly "bitter pill" to swallow for the GOP, but it's what needs to happen for the sake of the American people.

Jul 17, 2017:

This evening, GOP Senators Mike Lee (Utah) and Jerry Moran (Kansas) said they can't support the latest version of the Better Care Reconciliation Act, which means there are not enough votes in the Senate to pass the legislation (GOP Senators Susan Collins (Maine) and Rand Paul (Kentucky) have previously said they would not support the legislation).

Senate Majority Leader Mitch McConnell (Republican-Kentucky) responded by saying he will push for a repeal of Obamacare now, and delay legislation on replacement until after the 2018 mid-term elections.

Jul 16, 2017:

http://thehill.com/homenews/administration/342245-hhs-secretary-price-more-people-will-be-covered-under-gop-bill-than
https://www.realclearpolitics.com/articles/2017/07/15/pence_tells_us_governors_its_time_for_end_of_obamacare_134483.html

Jul 14, 2017:

http://thehill.com/policy/healthcare/342161-kasich-spokesman-pences-healthcare-claims-false
http://thehill.com/homenews/senate/342176-dem-senator-blasts-evil-epidemic-rate-of-lying-on-gop-healthcare-bill
http://theweek.com/articles/711793/end-mitch-mcconnell-master-strategist

Jul 13, 2017:

Jul 12, 2017:

Jul 11, 2017:

Jul 10, 2017:

Jul 9, 2017:

http://thehill.com/homenews/senate/341197-wva-republican-if-i-have-to-be-that-one-person-to-kill-healthcare-bill-i-will
http://thehill.com/policy/healthcare/341185-mccain-on-healthcare-bill-my-view-is-its-probably-going-to-be-dead

Jul 8, 2017:

http://thehill.com/homenews/senate/341061-gop-pessimism-rising-on-obamacare-repeal

Jul 6, 2017:

Jul 5, 2017:

Jul 1, 2017:

http://thehill.com/policy/healthcare/340322-democrats-go-in-for-the-kill-on-obamacare-repeal

Jun 30, 2017:

http://thehill.com/blogs/blog-briefing-room/news-other-administration/340200-trump-repeal-obamacare-now-replace-it

Jun 29, 2017:

http://thehill.com/homenews/senate/340183-gop-scrambles-to-win-centrist-votes-on-obamacare-repeal
http://www.denverpost.com/2017/06/29/opioid-battle-funding-healthcare-bill/
http://www.pbs.org/newshour/bb/america-stand-just-wealth-says-warren-buffett/
https://www.inc.com/minda-zetlin/heres-how-warren-buffett-thinks-we-should-fix-american-health-care.html
http://www.businessinsider.com/warren-buffett-munger-aetna-ceo-trump-on-single-payer-healthcare-2017-5

Jun 28, 2017:

http://thehill.com/policy/healthcare/339956-gop-infighting-erupts-over-healthcare-bill
http://thehill.com/blogs/floor-action/senate/339876-schumer-to-trump-meet-with-democrats-on-healthcare
http://www.politico.com/story/2017/06/28/health-care-polls-republicans-240062

Jun 27, 2017:

Three more Senate Republicans, Jerry Moran (Kansas), Shelley Moore Capito (West Virginia), and Rob Portman (Ohio), said they don't support the Better Care Reconciliation Act in its current form.

http://www.huffingtonpost.com/entry/elizabeth-warren-single-payer_us_595256bfe4b02734df2d528f

Jun 26, 2017:

The Congressional Budget Office (CBO) released its analysis of the Senate GOP Better Care Reconciliation Act, saying it would leave 22 million Americans uninsured over the next decade. View the analysis here.

James Madara, CEO and executive vice president of the American Medical Association, expressing his concern about the Better Care Reconciliation Act, in a letter to Senate Majority Leader Mitch McConnell and Senate Minority Leader Chuck Schumer said the following:

Medicine has long operated under the precept of Primum non nocere, or 'first, do no harm.' The draft legislation violates that standard on many levels.

In the letter, Madara also mentioned the following:

  • "...it seems "highly likely" that the bill "will expose low and middle income patients to higher costs and greater difficulty in affording care."
  • concern over the bill's intent to impose per-capita spending caps on Medicaid
  • concern over the the way the bill will limit the growth of Medicaid expenditures below the rate of medical inflation
  • concern over the elimination of funding for "expanded and sustained national investments in prevention and public health, to improve health outcomes, and to enhance health care quality" (currently a part of Obamacare)
  • concern over the defunding of Planned Parenthood

Source:

Madara, James. (June 26, 2017). "Letter to Senate Majority Leader Mitch McConnell and Senate Minority Leader Chuck Schumer". Retrieved 2017-06-26.

Jun 25, 2017:

Jun 24, 2017:

http://www.reuters.com/article/us-usa-healthcare-idUSKBN19E1DB
http://www.vanityfair.com/news/2017/06/senate-health-care-bill-medicaid-cuts

Jun 23, 2017:

Senator Dean Heller (Republican-Nevada) announced that he is opposed to the health care legislation announced yesterday, in its current form, bringing the total number of Senate Republicans show oppose the bill "as is" to five.

http://thehill.com/homenews/senate/339206-fifth-gop-senator-announces-opposition-to-obamacare-repeal-bill

Jun 22, 2017:

Senate Republicans announced their Obamacare replacement health care bill called the Better Care Reconciliation Act of 2017. View a breakdown of the bill here.

Four GOP senators, Rand Paul (Kentucky), Mike Lee (Utah), Ted Cruz (Texas), and Ron Johnson (Wisconsin), released a statement saying they don't support the health care legislation announced today.

http://thehill.com/policy/healthcare/339081-rocky-rollout-for-senate-healthcare-bill
http://www.reuters.com/article/us-usa-healthcare-idUSKBN19D13F
http://www.newyorker.com/news/news-desk/what-the-senate-health-care-bill-means-for-america
http://theweek.com/articles/707605/9-trump-promises-gops-better-care-act-breaks
http://thehill.com/homenews/senate/339008-four-senate-conservatives-say-they-oppose-obamacare-repeal-bill
http://thehill.com/policy/healthcare/338947-senate-gop-releases-obamacare-repeal-bill-with-deep-cuts-to-medicaid

Jun 21, 2017:

Jun 20, 2017:

Jun 19, 2017:

Senate Democrats held an 8-hour "talkathon" expressing their concerns over the GOP's plan to repeal and replace Obamacare.

In addition to others, speakers included House Minority Leader Charles Schumer (New York), Sheldon Whitehouse (Rhode Island), Joe Donnelly (Indiana), Ron Wyden (Oregon), Diane Feinstein (California), Corey Booker (New Jersey), Elizabeth Warren (Massachusetts), Bernie Sanders (Vermont), Richard Blumenthal (Connecticut), and Tammy Baldwin (Wisconsin).

The overriding concerns expressed by Democrats were:

  • cuts to Medicaid
  • increased premiums for the elderly
  • reduced taxes for the rich at the expense of those less fortunate
  • the "behind closed doors" process by which 13 Senate Republicans are drafting the bill (the lack of hearings, meetings, committees, etc.)
  • the GOP plan to repeal and replace, rather than fix Obamacare

Charles Schumer referred to the "behind closed doors" process for a bill that affects so many people as "...the greatest miscarriage of legislative practice that I've seen since I've been here in the House and Senate."

Schumer asked Senate Majority Leader Mitch McConnell (Republican-Kentucky), who was present at the time, for a bi-partisan meeting with all 100 senators to discuss the GOP plan for repeal and replace. McConnell declined. When Schumer expressed his concern about the lack of time lawmakers will have to review the bill before a vote McConnell said there will be "ample opportunity".

Joe Donnelly expressed his concern that the Trump administration, right from the first day in office, has helped to "destabilize" and "undermine" our current health care system, instead of trying to prop it up. Donnelly quoted Trump as saying "...to let Obamacare explode. Let it be a disaster, because we can blame that on the Democrats." Donnelly also said "...this makes no sense. If your house needs repairs, you don't set the house on fire, you work to fix the issues."

To watch the entire talkathon on C-SPAN, view a transcript, or get a list of all speakers, go here.

Jun 13, 2017:

Jun 11, 2017:

Jun 8, 2017:

Jun 2, 2017:

http://thehill.com/policy/healthcare/336054-gop-senator-healthcare-deal-unlikely-this-year

May 24, 2017:

The CBO released its analysis of the AHCA passed by the U.S. House of Representatives on May 4 ("H.R.1628 - American Health Care Act of 2017"). View the analysis here.

Senator Susan Collins (Republican-Maine) released a statement urging lawmakers to support the Obamacare replacement bill introduced by her and her Republican colleagues (Bill Cassidy (Louisiana), Shelley Moore Capito (West Virginia), and Johnny Isakson (Georgia)) on January 23, 2017 ("S.191 - Patient Freedom Act of 2017 | congress.gov").

May 7, 2017:

May 6, 2017:

At a town hall meeting at Lewis-Clark State College in Lewiston, Idaho, Representative Raul Labrador (Republican-Idaho), a member of the House Freedom Caucus, said the following:

Nobody dies because they don’t have access to health care.

Last month, Labrador said that health care is not a "basic human right".

Source:

Smilowitz, Elliot. "GOP rep: 'Nobody dies because they don’t have access to healthcare'". The Hill. Retrieved 2017-05-09.

Savransky, Rebecca. "GOP rep booed at town hall for saying healthcare isn’t a 'basic human right'". The Hill. Retrieved 2017-05-09.

May 4, 2017:

By a vote of 217-213 the U.S. House of Representatives passed the amended AHCA bill. All Democrats voted against the bill, including 20 Republicans.

Some Senate Republicans said they cannot support the bill in its current form.

May 3, 2017:

House Majority Leader Kevin McCarthy (Republican-California) said the House will vote tomorrow on an amended AHCA bill to repeal and replace Obamacare.

Representative Fred Upton (Republican-Michigan) and Representative Billy Long (Republican-Missouri) said they would support the bill after a new amendment from Upton. The Upton amendment adds an additional $8 billion over five years to fund high-risk pools and go toward patients with pre-existing conditions in states that seek waivers (the amended AHCA bill already includes $130 billion for this).

The U.S. Congressional Budget Office (CBO) has not had an opportunity to do its analysis on the bill.

Senate Minority Leader Chuck Schumer (Democrat-New York) said that the amended AHCA bill will not pass the Senate.

Apr 26, 2017:

The House Freedom Caucus announced it will support the MacArthur amendment.

Apr 20, 2017:

According to a draft proposal obtained by Politico, Tom MacArthur (Republican-New Jersey), co-chairman of the moderate Tuesday Group, is proposing an idea that would allow states to apply for "limited waivers" from both the EHB requirement and the community rating requirement of Obamacare.

The EHB requirement (more info at the top of this post) establishes a minimum set of benefits that all health insurance plans must have. The community rating requirement mandates that insurers charge people of the same age living in the same area the same premiums (without this requirement, insurers could charge more for people with pre-existing conditions).

This proposed change to the original AHCA bill put forth by the House GOP has been dubbed the MacArthur amendment.

Apr 6, 2017:

House Speaker Paul Ryan announced a proposal put forth by Representative Gary Palmer (Republican-Alabama) and David Schweikert (Republican-Arizona), both members of the House Freedom Caucus. The proposal, dubbed the Palmer amendment, creates a $15 billion (over nine years) Federal Invisible Risk Sharing Program which would reimburse health insurance companies for high-cost individuals starting in 2018.

Mar 25, 2017:

Trump tweeted the following:

ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!

Source:

Smilowitz, Elliot. "Trump tweets: We'll put together a great plan after Obamacare explodes". The Hill. Retrieved 2017-03-26.

Mar 24, 2017:

Around mid-afternoon, House Speaker Paul Ryan met with Trump to tell him there weren't enough "yes" votes to pass the AHCA bill. Trump told Ryan to bypass the vote, so no vote was taken.

Read a transcript of Trump's response to the bill failure here.

Senator Bernie Sanders (Independent-Vermont) released a statement entitled "Sanders Statement on Defeat of Republican Health Care Bill" which says the following:

The defeat of the disastrous Trump-Ryan health care bill is a major victory for the working families of this country and for the hundreds of thousands who attended rallies and town hall meetings in opposition to this bill. What the defeat of this bill shows is that the American people will not accept legislation that provides huge tax breaks to billionaires while 24 million people are kicked off their health insurance, massive cuts are made to Medicaid and Planned Parenthood and premiums for senior citizens are dramatically increased. Our job is to improve the Affordable Care Act, not repeal it. Our job is to guarantee health care to all people as a right, not a privilege.

Listen to Senator Bernie Sander's response to the bill failure in an interview by Chris Hayes on MSNBC's All In here.

Listen to Micheal Moore's response to the bill failure in an interview by Chris Hayes on MSNBC's All In here.

Mar 23, 2017:

The House decided to delay the vote on the AHCA bill until tomorrow because it still does not have the needed 216 votes to pass.

The CBO released revised estimates taking into account the recent modifications made to the AHCA bill. The estimates say the revised bill would be more costly than the original bill (reducing federal deficits by $150 billion over 10 years versus $337 billion with the original bill). Read the entire CBO report here.

An article on the NBC News website entitled "Republican Health Care Vote: Everything You Need to Know" is a good resource which explains the essentials of the Republican AHCA bill and how it differs from Obamacare.

At an evening House GOP meeting, Budget Director Mick Mulvaney told those in attendance that Trump wants a vote on the AHCA bill tomorrow (Friday) and if the bill fails to pass that Trump will move on to other issues and leave Obamacare as the nation's health care law.

On March 8, 2017, Trump indicated that if the House can't pass a health care bill, he will just let Obamacare and fail and blame Democrats.

Commentary:

Obviously, the political implications of a vote on the AHCA bill are enormous. Republicans have been talking Obamacare repeal and replace for many years and it was a major Trump campaign promise.

If House Republicans can't pass a bill and if Trump does indeed just "move on" and let Obamcare decline, that would open the door for Democrats to come up with a bill to fix, or at least improve, Obamacare. Would Republicans support such a bill? If so, it seems it would be a very "bitter pill to swallow" considering their distaste for Obamacare and their failed effort to repeal and replace it. Yet, it they didn't support it they would be seen, once again, as the party of "NO", and they would be seen as responsible for allowing Obamacare to continue to decline.

And what about Trump? Would he even sign such a bill if it passed both the House and the Senate?

Beyond that, it seems to me there is more concern about just getting a bill passed, for political reasons, than there is about creating a bill that sincerely addresses the issue of affordable health care for all Americans.

Mar 22, 2017:

After a long day of meetings, it appears that House conservatives still can't come to an overall agreement on the AHCA. Representative Charlie Dent (Republican-Pennsylvania), the leader of the moderate Tuesday Group n the House, released a statement opposing the AHCA bill.

Two well-funded Koch brothers groups, Americans for Prosperity and Freedom Partners, pledged major financial support to GOP House representatives who oppose the AHCA.

Mar 21, 2017:

Trump held meetings with House Republicans emphasizing the political consequences of not getting an Obamacare repeal and replace bill passed.

Health & Human Services Secretary Tom Price appeared on the Hugh Hewitt radio program. Read a transcript of the interview here.

Mar 20, 2017:

House Republicans released a modified version of their AHCA bill in an effort to get more house Republican support for a floor vote scheduled for March 23.

Here's a summary of the modifications:

  • tax credits remain the same is in the first version of the bill
  • starting in 2018, taxpayers can deduct health care expenses over 5.8 percent of their income (versus 7.5 percent in the first bill)
  • all ACA (Obamacare) taxes are eliminated as soon as the bill is passed (versus in 2018 in the first bill)
  • the 19 states not currently singed up for the Medicaid expansion cannot signup for the expansion
  • states signed up for Medicaid can choose to have their Medicaid funds paid in a block grant (rather than as a set amount of spending per recipient)
  • states signed up for Medicaid can add a work requirement for non-pregnant adults on Medicaid

Source:

Desjardins, Lisa. (March 21, 2017). "Here's how Republicans just changed their health care bill". PBS. Retrieved 2017-03-22.

Chairman of the House Freedom Caucus Mark Meadows (Republican-North Carolina) told reporters that the Caucus (a House group opposed to the AHCA bill) is not taking any official position on the AHCA bill.

Mar 15, 2017:

The Trump administration announced that 12.2 million people signed up for Obamacare for 2017.

Mar 13, 2017:

The U.S. Congressional Budget Office (CBO) released its report on the American Health Care Act (AHCA).

In summary, the report estimates the following:

  • implementation of the AHCA would decrease U.S. federal deficits by $337 billion over the next decade
  • under the AHCA, in 2018 14 million more people would be uninsured than under current law, with that number rising to 21 million in 2020, and 24 million in 2026
  • under the AHCA, by 2026 52 million people would be uninsured compared to 26 million uninsured under current law

Read the entire CBO report here.

Yesterday, Trump administration officials continued to downplay the validity of the CBO and its forthcoming report on the AHCA.

Speaking with host George Stephanopoulos on ABC's This Week, Director of the Office of Management and Budget Mick Mulvaney said:

...if the CBO was right about Obamacare to begin with, there would be eight million more people on Obamacare today than there actually are. So I love the folks at the CBO. They work really hard. They do, but sometimes we ask them to do stuff they're not capable of doing, and estimating the impact of a bill of this size probably isn't the -- isn't the best use of their time.

Read a transcript of the entire interview here.

On Fox News Sunday, White House Chief Economic Adviser Gary Cohn said:

In the past, the CBO score has really been meaningless.

Source:

Fox News. (March 12, 2017). "White House vows plan will offer insurance to every American, downplays upcoming CBO report". Fox News. Retrieved 2017-03-13.

Mar 9, 2017:

After 44 total hours of proceedings and deliberations, two different committees in the U.S. House of Representatives voted to approve the American Health Care Act.

The Energy and Commerce Committee voted 31-23 in favor and the Ways and Means Committee voted 23-16 in favor, 100 percent along party lines.

Next Wednesday, the House Budget Committee is scheduled to have a merged version of the bill ready for a formal vote in the House.

Yesterday, Andrey Ostrovsky, chief medical officer for The Center for Medicaid and CHIP Services (CMCS) tweeted the following:

Despite political messaging from others at HHS, I align with the experts from @aafp @AmerAcadPeds @AmerMedicalAssn in opposition to #AHCA

Source:

Berger, Judson. (March 9, 2017). "ObamaCare repeal bill hit by Medicaid official, exposing rift in Trump team". Fox News. Retrieved 2017-03-09.

In a March 3, 2017 Stat News article entitled "Two months ago, this doctor was delivering babies. Now he's at the nexus of the Obamacare fight", first-term Representative Roger Marshall (Republican-Kansas) and a member of the GOP Doctors Caucus said the following regarding Medicaid expansion under Obamacare and poor people:

Just like Jesus said, 'The poor will always be with us.' There is a group of people that just don't want health care and aren't going to take care of themselves.

Just, like, homeless people. I think just morally, spiritually, socially, [some people] just don't want health care. The Medicaid population, which is [on] a free credit card, as a group, do probably the least preventive medicine and taking care of themselves and eating healthy and exercising. And I'm not judging, I'm just saying socially that's where they are. So there's a group of people that even with unlimited access to health care are only going to use the emergency room when their arm is chopped off or when their pneumonia is so bad they get brought [into] the ER.

Mar 8, 2017:

Trump met with a number of conservative groups in an effort to help "sell" the AHCA.

In attendance were FreedomWorks, Club for Growth, Heritage Action, Americans for Prosperity, and the Tea Party Patriots.

According to sources at the meeting, if for any reason Republicans can't get an Obamacare replacement bill passed, Trump plans to let Obamacare fail and blame Democrats for the result.

The American Medical Association (AMA), the American College of Physicians, the American Academy of Family Physicians, the American Psychiatric Association, the American Association of Retired Persons (AARP), the American Hospital Association, the Federation of American Hospitals, and America's Health Insurance Plans (AHIP) have all voiced serious concerns over the AHCA as it is written.

Basically, the concerns over the AHCA fall into three areas:

  • the basis for determining the amount of a subsidy (tax credit) has been changed from income (under Obamacare) to age (under the AHCA), which might mean that some people will have to pay more for health insurance or might not be able to afford it at all (younger people receive smaller subsidies), making the overall health insurance market less certain for insurers
  • the individual mandate to purchase insurance is eliminated, which might mean that not as many younger, healthy people will sign up for health insurance, making for a smaller overall pool of people paying premiums, causing premiums for those who are signed up to increase
  • in 2020 the current Medicaid expansion under Obamacare is eliminated, which might result in a significant number of people without health insurance

Source:

Tracer, Zachary; Edney, Anna. (March 8, 2017). "Doctor, Hospital Groups Line Up Against GOP Health Proposal". Bloomberg News. Retrieved 2017-03-09.

Parks, Maryalice. (March 9, 2017). "The 3 key provisions in the GOP health care bill that cause experts concern ". ABC News. Retrieved 2017-03-09.

It's also worth noting that repealing Obamacare will result in a substantial tax-cut for the wealthiest Americans. Read an excellent discussion of this on the Forbes website here.

Even before the non-partisan "Congressional Budget Office (CBO)" has completed its report on the AHCA, Press Secretary Sean Spicer questioned the accuracy of the past work done by the CBO. Spicer also said that a separate report will be compiled by the U.S. Office of Management and Budget headed by Director Mick Mulvaney.

This past week, Health & Human Services Secretary Tom Price talked about the three phases of the Trump administration's plan to repeal and replace Obamacare.

Phase 1 is the AHCA bill just introduced in the House of Representatives.

Phase 2 involves regulatory adjustments.

Phase 3 is passing legislation that lets insurance companies sell policies across state lines or allow the government to use its purchasing power to negotiate lower drug prices.

Mar 7, 2017:

The New York Times has an article entitled "The Parts of Obamacare Republicans Will Keep, Change or Discard" which breaks down the essential provisions of the AHCA and how they relate to Obamacare.

http://www.politico.com/story/2017/03/jason-chaffetz-new-gop-health-care-plan-235762
http://www.usatoday.com/story/news/politics/onpolitics/2017/03/07/charles-koch-david-koch-obamacare-repeal-opposition/98851754/
http://www.politico.com/story/2017/03/trump-health-care-plan-tweets-235761
https://www.nytimes.com/2017/03/07/us/politics/affordable-care-act-obama-care-health.html
http://money.cnn.com/2017/03/06/news/economy/republicans-obamacare-repeal-replacement-bill/
http://www.npr.org/2017/03/07/519020153/trump-supports-gop-health-care-plan-but-it-isn-t-everything-he-wants

Mar 6, 2017:

http://www.speaker.gov/press-release/statement-introduction-american-health-care-act
http://www.speaker.gov/general/american-health-care-act-fact-sheet
http://www.speaker.gov/general/american-health-care-act-what-you-need-know
https://housegop.leadpages.co/healthcare/

http://www.cnn.com/2017/03/06/politics/republicans-public-obamacare-plan/
https://www.nytimes.com/2017/03/06/us/politics/affordable-care-act-obamacare-health.html

Feb 28, 2017:

In the U.S. House of Representatives, some conservatives are objecting to the idea of using tax credits to help consumers pay for their healthcare saying the credits are an "entitlement".

Senators Mike Lee of Utah, Rand Paul of Kentucky, and Ted Cruz of Texas said they will "accept nothing less than full repeal of Obamacare."

Source:

Werner, Erica (Associated Press); Fram, Alan (Associated Press). (January 20, 2017). "Conservatives rebel on health care, and GOP looks to Trump". ABC News. Retrieved 2017-02-28.

Feb 24, 2017:

A draft U.S. House of Representatives Obamacare replacement bill leaked by a lobbyist proposes a tax credit between $2,000 and $4,000 to help consumers afford insurance. The credit would increase based on a person's age.

Because the amount of the credit is based on age and not income (the way it is under ObamaCare) Democrats say not enough help is given to low-income people. Republicans say income-based credits discourage work.

Feb 16, 2017:

GOP leaders in the U.S. House of Representatives shared a document with other GOP representatives which outlines a replacement plan for Obamacare. Among other things, the plan does not maintain the Medicaid expansion as it currently exists under Obamacare.

Feb 1, 2017:

Jan 27, 2017:

The Trump administration pulled the last $4-$5 million of Obamacare ads in the final days of open enrollment set to end on January 31. The Obama administration had contracted a private advertising firm for about $75 million for ads to run from November 1, 2016 through January 31, 2017.

Jan 26, 2017:

This week in the U.S. Senate, two Obamacare replacement bills were introduced.

Bill Cassidy (Republican-Louisiana) and Susan Collins (Republican-Maine) introduced "S.191 - Patient Freedom Act of 2017" on January 23.

Rand Paul (Republican-Kentucky) introduced "S.222 - Obamacare Replacement Act" on January 24.

Jan 20, 2017:

Trump signed his first executive order entitled "Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal."

The order says that until the Affordable Care Act is repealed, the executive branch must take actions to "minimize the unwarranted and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market."

The order also calls for the leaders of all federal agencies to prevent any Obamacare actions that would cause any regulatory or fiscal burden.

Source:

McGraw, Meridith. (January 20, 2017). "President Trump Signs Executive Order 'Minimizing the Economic Burden' of Obamacare". ABC News. Retrieved 2017-01-20.

An article written by John Wasik entitled "Trump's Stealth Health Plan Could Be 'Medicare For All'" which appeared on Forbes today discusses the possibility that Trump might support a healthcare plan called "Medicare For All (MFA)".

MFA is a universal, single-payer system. Read more about it here.

Another article written by John Wasik entitled "How Trump's Plan To Gut Obamacare Will Take Down Medicare" which appeared on Forbes on December 5, 2016 suggests that a full repeal of Obamacare would "severely damage Medicare".

Jan 13, 2017:

By a vote of 51-48, the U.S. Senate approved a budget blueprint (a procedural step) in preparation for a reconciliation bill which can be used to repeal significant parts of the ACA, and which is immune from being filibustered.

Sep 22, 2016:

http://thehill.com/policy/healthcare/297150-dems-to-gop-help-us-fix-obamacare

Commentary:

It seems to me it would be easier and less disruptive to keep the ACA and "tweak" the parts of it that need to be modified. The ACA wasn't intended to be a "cure all" for health insurance in the U.S. It was a "first cut" at an extremely complex problem. Why completely tear down a building, including it's foundation, and start over from scratch when you can just do some remodeling and make it more to your liking?

Of course, one of the things Republicans really dislike about Obamacare is that it is partially subsidized by the wealthy, and that's a huge issue for them. Beyond that, I think the motivation for "repeal" is more political than practical. Republicans "stone-walled" President Obama for eight years, fighting him "tooth-and-nail" every step of the way. I think it's safe to say that most Republicans don't like Obama (that's putting it diplomatically). I think they want to "stick it to him", and I think they don't want any legislation with his name on it (Obamacare) going forward.

All of the fuss about repeal and replacement of Obamacare, and about Obamacare itself, is really just "smoke and mirrors" when you break it all down. The "elephant in the room" that no one wants to talk about is that no health care law or system can provide adequate coverage for all Americans at a reasonable cost unless it does the following:

  • gets a very large number of people in one pool so there are enough people paying into the system to cover all the expenses of all the people receiving health care products and services
  • addresses the current and rising cost of prescription drugs, doctors fees, hospital costs, and all other health care related expenses and provides a way to control those costs

This means a single-payer system, which creates one very large pool of people paying into the system (via premiums, taxes, etc.) which assigns some entity (government or private) to negotiate the prices (costs) of health care products and services with providers.

It doesn't require a college degree to figure this out - it's simple math - yet few have been willing to even suggest it, let alone start work on a bill to accomplish it. Why? First, Republicans label this "socialized health care" and are flat out against it. Second, the political battle that would ensue with health insurance companies, pharmaceutical companies, and other health care providers (doctors, hospitals, medical supply companies, etc.) would be massive. Yet, this is what must happen in the United States if we are to solve the challenge of health care once and for all. And third, Democrats want everyone to be insured and have affordable health care. Republicans are not as concerned about this.

It's unfortunate that many years ago Republicans began screaming for "repeal and replace" and that Trump jumped on that same campaign "bandwagon". As a result, now there is enormous political pressure to follow through on those promises. It makes it nearly impossible for Republicans to even consider the alternative, which is amending the existing ACA law instead. And, it's the "repeal and replace" that so infuriates Democrats.

If Trump were a real leader he would get all key Republicans and Democrats to sit down in one room, put politics aside, and try to come up with a real, non-partisan, compromised solution. But, Trump has continued to bash Obamacare into his presidency, over and over again saying how it's disintegrating. He, and the American people, would have been better served by him refraining from that kind of talk and being more open to the idea of amending Obamacare and getting Republicans and Democrats to work together.

http://www.realclearpolitics.com/articles/2017/04/21/its_time_to_pull_the_plug_on_repeal-and-replace_133666.html

http://thehill.com/policy/healthcare/316429-senators-obamacare-replacement-bills-highlight-gop-divide
http://www.npr.org/2017/01/15/509960559/democrats-rally-in-dozens-of-cities-to-oppose-obamacare-repeal
http://www.npr.org/2017/01/13/509722777/democrats-hold-rallies-across-country-to-fight-gop-efforts-to-repeal-obamacare
http://thehill.com/homenews/house/313517-ryan-gops-goal-is-to-replace-repeal-obamacare-concurrently
http://www.reuters.com/article/us-usa-obamacare-ryan-idUSKBN14U1X1
http://thehill.com/policy/healthcare/312934-gop-wont-promise-obamacare-fix-will-cover-all
http://thehill.com/policy/healthcare/313038-obama-dares-gop-to-make-healthcare-plans-public
http://www.msn.com/en-us/news/politics/republicans%e2%80%99-4-step-plan-to-repeal-the-affordable-care-act/ar-BBxUxCr?li=BBnb7Kz&ocid=mailsignout
http://www.msn.com/en-us/news/politics/with-obamacare-gop-faces-the-%e2%80%98pottery-barn-rule%e2%80%99-you-break-it-you-own-it/ar-BBxU9FQ?li=BBnb7Kz&ocid=mailsignout
http://www.reuters.com/article/us-usa-obamacare-idUSKBN14O13R
http://www.msn.com/en-us/news/politics/us-senator-introduces-resolution-to-repeal-obamacare/ar-BBxRqSE?li=BBnb7Kz&ocid=mailsignout
http://www.nytimes.com/2016/12/30/opinion/snatching-health-care-away-from-millions.html
http://www.usatoday.com/story/news/politics/2016/12/05/paul-ryan-obamacare-phaseout-leave-no-one-worse-off/95002488/
http://www.nytimes.com/2016/12/06/business/health-insurers-obamacare-republicans.html
https://www.washingtonpost.com/national/health-science/hospitals-warn-trump-congress-of-massive-losses-with-affordable-care-act-repeal/2016/12/06/3de2f7de-bbd8-11e6-91ee-1adddfe36cbe_story.html?utm_term=.a5e3c53251a3
http://abcnews.go.com/Politics/wireStory/mcconnell-cautions-replacement-health-law-time-43948747
http://www.nytimes.com/2016/11/29/us/tom-price-trump-health-secretary.html
http://www.nytimes.com/2016/12/02/us/politics/obamacare-repeal.html
http://paulryan.house.gov/healthcare/

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