'All hands on deck' for GOP, Trump as health care vote approaches

Washington (CNN)President Donald Trump warned his fellow Republicans of big losses at the ballot box if they fail to repeal and replace Obamacare.

Wednesday and Thursday, we'll learn if House Republicans heed that message and back legislation that has already tested the President's political prowess and has Trump and House Speaker Paul Ryan furiously counting every available vote.
 
"This is an all-hands-on deck situation," a senior House GOP aide said Tuesday.
 
According to CNN's ongoing whip count as of Wednesday morning, 21 House Republicans have flat-out said they will vote against the bill to repeal or replace Obamacare, while five more have indicated they are likely to oppose it.
 
Trump and Ryan must get 216 Republicans on board and can afford only 21 defections, if no Democrat joins them.
 
 
 
Trump has filled his schedule with back-to-back meetings with GOP lawmakers in recent days, and will continue the behind-the-scenes lobbying on Wednesday along with Vice President Mike Pence and Health and Human Services Secretary Tom Price.
 
Meanwhile, Ryan's whip operation is in full blitz mode. The House speaker has been texting with Freedom Caucus Chairman Mark Meadows, who has not budged. House Whip Steve Scalise and Deputy Whip Patrick McHenry have also been singling out individual Freedom Caucus members to try to peel them away from the group.
 
Various lawmakers who are planning to vote "no" have described to CNN having 30-45 minute phone calls with Trump officials in the past 36 hours.
 
Trump once again publicly pressed the importance of getting the health care bill through the House this week in a speech Tuesday night.
 
"The American people gave us clear instructions. It's time to get busy, get to work and get the job done," Trump said at a dinner hosted by the National Republican Congressional Committee. "That legislative effort begins with Thursday's crucial vote and it really is a crucial vote for the Republican Party and for the people of the country."
 
Wednesday morning will bring the last official procedural stepping stone before the bill heads to the House floor -- the Rules Committee, a panel traditionally full of leadership loyalists, which should clear the way to consider amendments to the measure and set up Thursday's dramatic vote.
 
That's an important step, but it's the arm-twisting that happens in closed-door meetings that will the difference.
 
 
Still stubbornly opposed to the health care proposal are members of the conservative Freedom Caucus, who insist they have more than 21 "no" votes to sink the bill.
 
According to a source, the caucus' members have been invited to visit the White House in small groups in recent days -- an effort by administration officials to start peeling off members. That visit is likely to continue Wednesday, the source said.
 
Reservations about the bill span the party's political spectrum.
 
Trump met with some members of the moderate Republican "Tuesday Group" on Tuesday, and for one of those members, face time with the president wasn't enough to sway him.
 
"I'm a no," GOP Rep. Leonard Lance told reporters after returning from a meeting with Vice President Mike Pence.
 
Lance, who Democrats view as vulnerable in 2018, said he was still hung up on the fear that his older constituents would have to shoulder higher coverage costs under the Republican bill. "I indicated to the President my concerns in several areas," Lance said, as he suggested that the chance to make further changes to the legislation was closed.
 

What's in the bill

The bill introduced earlier this month would roll back many of the Obamacare taxes and eradicate the individual mandate. Instead of the subsidies available in the Affordable Care Act, the GOP plan provides Americans with refundable tax credits to purchase health insurance.

The bill also significantly restructures Medicaid and allows states to require able bodied adults to work if they want to be eligible for the program. After 2020, states will no longer be able to expand Medicaid like they could under Obamacare and states that haven't expanded the program at all are bared from doing so.
 
The GOP bill, however, still includes some of the most popular pieces of Obamacare, including protections for people with pre-existing conditions (though insurers would be allowed to charge higher premiums to individuals whose coverage has lapsed) and letting children stay on their parents' insurance plans until the age of 26.
 
The non-partisan Congressional Budget Office's analysis of the bill predicted that 24 million Americans may lose their insurance by 2026 if the bill is enacted.
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Trump’s approval rating is in a free fall

President Trump’s approval rating has taken a nosedive, according to the latest Gallup poll.

Only 37 percent of respondents approve the job the president is doing — the lowest level since he took office — while 58 percent disapprove, the poll found.

Trump’s approval rating was 45 percent a week earlier.

Other presidents have experienced even lower ratings, but Trump is the first commander-in-chief in at least 70 years to have dropped this low by March of his first term, according to Gallup.

His plummeting numbers come as the GOP seeks to push through the proposal to repeal and replace the Affordable Care Act, better known as ObamaCare.

Trump also has faced a roadblock with his revised travel ban after a federal judge in Hawaii issued a temporary restraining order against it.

“We’re going to take our case as far as it needs to go, including all the way up to the Supreme Court,” Trump told a crowd during a rally in Tennessee last week. “We’re going to win. The danger is clear. The law is clear. The need for my executive order is clear.”

Trump also has faced criticism for his handling of alleged Russian ties and his tweeted claim that President Obama “wire tapped” Trump Tower.

FBI Director James Comey is expected to testify Monday before the House Intelligence Committee about Russia’s involvement in the 2016 election and the still-unproven wiretapping claim.

Earlier this month, a Fox News poll showed Trump’s approval rating had dropped by 5 percentage points since last month.

The survey found that 43 percent of voters approved of the job he was doing compared to 51 percent who did not.

The Gallup poll, which included about 1,500 adults nationwide, has a margin of error of plus or minus 3 percentage points.

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Republicans on defense after report shows millions would lose insurance

Republicans on Tuesday defended their plan to dismantle Obamacare after a bipartisan report showed 14 million Americans would lose medical insurance by next year under their proposal even as it reduces the budget deficit.

The U.S. Congressional Budget Office, a research agency, on Monday forecast that by 2026, the number of people without health insurance would increase by 24 million people if the House of Representatives' legislation to replace the 2010 Affordable Care Act is adopted.

The Trump administration defended the replacement plan, saying it will offer consumers more choices.

Hospital and insurer stocks fell Tuesday morning, with Community Health Systems Inc off 3.2 percent and Tenet Healthcare Corp off 5.4 percent.

Medicaid and Medicare specialists WellCare Health Plans Inc and Centene Corp were both off 1.9 percent.

CBO's report complicated the plan by congressional Republicans who have vowed for seven years to undo Obamacare. President Barack Obama's signature domestic policy expanded health insurance to about 20 million Americans.

The measure faces opposition from a range of Republicans - from conservatives who think it does not go far enough to moderates concerned about the impact on coverage and costs.

White House budget director Mick Mulvaney dismissed CBO's ability to analyze health care coverage and said the focus should not be on how many people are insured.

"Coverage is not the end. People don't get better with coverage, they get better with care," he told MSNBC.

Separately, a White House analysis showed 26 million people would lose coverage over the next 10 years, Politico reported, citing an Office of Management and Budget document.

Mulvaney told CNN he was unaware of that document.

President Donald Trump, who campaigned on a pledge to repeal and replace Obamacare and has vowed to provide insurance for everybody, has yet to comment on the report.

He was scheduled to speak on Tuesday with Joseph Swedish, the chief executive officer of health insurer Anthem Inc, and U.S. Health and Human Services Secretary Tom Price as well as top House Republican leaders.

Price told NBC on Tuesday: "Every single American will have access and have the financial feasibility to purchase it."

Before the CBO issued its report, House Republicans had hoped to vote soon on the bill before sending it to the Senate, where its outlook is uncertain.

Overall, CBO projected that 52 million people would be uninsured by 2026 if the bill became law, compared with 28 million who would not have coverage that year if Obama's Affordable Care Act remained unchanged.

CBO also said federal deficits would fall by $337 billion between 2017 and 2026 under the Republican bill.

Democrats say the plan could hurt the elderly, poor and working families while giving tax cuts for the rich.

Doctors, hospitals and other medical providers as well as patient advocates have urged lawmakers to abandon it.

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Health Law’s Repeal Could Raise Costs and Number of Uninsured, New Report Says

WASHINGTON — Repealing major provisions of the Affordable Care Act, while leaving other parts in place, would cost 18 million people their insurance in the first year, a report by the nonpartisan Congressional Budget Office said on Tuesday. A repeal could increase the number of uninsured Americans by 32 million in 10 years, the report said, while causing individual insurance premiums to double over that time.

The budget office analyzed the probable effects of a Republican bill repealing the law like the one approved in Congress, but vetoed early last year by President Obama.

The C.B.O. report, released after a weekend of protests against repeal, will only add to the headaches that President-elect Donald J. Trump and congressional Republicans face in their rush to gut President Obama’s signature domestic achievement as they try to replace it with a health insurance law more to their liking.

Republicans cautioned that the report painted only part of the picture — the impact of a fast repeal without the Republican replacement. They said the numbers in the report represented a one-sided hypothetical scenario.

“Today’s report shows only part of the equation — a repeal of Obamacare without any transitional policies or reforms to address costs and empower patients,” said the chairman of the Senate Finance Committee, Orrin G. Hatch, Republican of Utah. “Republicans support repealing Obamacare and implementing step-by-step reforms so that Americans have access to affordable health care.”

But that replacement bill has yet to be produced, and existing Republican plans, such as one drafted by Representative Tom Price of Georgia, now selected to be Mr. Trump’s secretary of Health and Human Services, have yet to be scrutinized by the budget office, the official scorekeeper of legislation.

The bill that the budget office analyzed would have eliminated tax penalties for people who go without insurance. It would also have eliminated spending for the expansion of Medicaid and subsidies that help lower-income people buy private insurance. But the bill preserved requirements for insurers to provide coverage, at standard rates, to any applicant, regardless of pre-existing medical conditions.

“Eliminating the mandate penalties and the subsidies while retaining the market reforms would destabilize the nongroup market, and the effect would worsen over time,” the budget office said.

The office said the estimated increase of 32 million people without coverage in 2026 resulted from three changes: about 23 million fewer people would have coverage in the individual insurance market, roughly 19 million fewer people would have Medicaid coverage, and there would be an increase in the number of people with employment-based insurance that would partially offset those losses.

The estimates by the budget office are generally consistent with projections by the Obama administration and by insurance companies.

In its report, the budget office said that repealing selected parts of the health care law — as specified in the earlier Republican bill — would have adverse effect on insurance markets.

In the first full year after enactment of such a bill, it said, premiums would be 20 to 25 percent higher than under current law.

Repealing the penalties that enforce the “individual mandate” would “both reduce the number of people purchasing health insurance and change the mix of people with insurance,” as younger and healthier people with low health costs would be more likely to go without insurance, the budget office said.

The Republican bill would have eliminated the expansion of Medicaid eligibility and the subsidies for insurance purchased through Affordable Care Act marketplaces, after a transition period of about two years.

Those changes could have immediately increased the number of uninsured by 27 million, a number that would gradually increase to 32 million in 2026, the budget office said.

Without subsidies, the budget office said, enrollment in health plans would shrink, and the people who remained in the individual insurance market would be sicker, with higher average health costs. These trends, it said, would accelerate the exodus of insurers from the individual market and from the public marketplaces.

As a result, it said, about half of the nation’s population would be living in areas that had no insurer participating in the individual market in the first year after the repeal of marketplace subsidies took effect. And by 2026, it estimated, about three-quarters of the population would be living in such areas.

Republicans have complained bitterly about the reduction in health plan choices for consumers under the Affordable Care Act. But the effects projected by the budget office would be much more severe.

While writing the Affordable Care Act in 2009 and 2010, lawmakers continually consulted the Congressional Budget Office to understand the possible effects on spending, revenue and insurance coverage. The current director of the budget office, Keith Hall, who signed the report issued on Tuesday, was selected and appointed by Republican leaders of Congress in 2015.

Chris Jacobs, a conservative health policy analyst who once worked for Republicans on Capitol Hill, said the Trump administration could, by regulation, mitigate some of the effects on insurance markets and premiums described by the budget office.

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US Senate passes measure to take first step in dismantling Obamacare

US senators have passed the first measure on the way to dismantling outgoing-President Barack Obama’s much debated health care law, commonly known as Obamacare.

‘Broken promises’ or ‘sick again’? New Congress draws battle lines over Obamacare

@McConnellPress @SenateMajLdr McConnell votes to take important step toward repeal.

Early on Thursday, the Senate voted 51-48 in favor of a nonbinding Republican-backed budget measure that will make it easier to pass repeal legislation, which could be voted on as early as next month.

It's official. The process of repealing in order to replace with a patient-centered alternative has officially begun.

Republicans plan to get rid of the law and replace parts of it by the end of February, according to House Majority Leader Kevin McCarthy, speaking on “The Hugh Hewitt Show”, a conservative radio program, on Wednesday. Other Republicans, however, say the process could take longer.

The senators who voted against the new measure on Thursday were quick to voice their discontent with the outcome on Twitter. Calling the vote “shocking,” “immoral,” and “shameful,” they warned of the possible consequences of repealing Obamacare with no replacement, stating that millions of Americans could lose their insurance.

The House is scheduled to vote on the measure on Friday. If passed, it would allow follow-up legislation to avoid a filibuster by Senate Democrats, a congressional procedure in which debate over a proposed piece of legislation is extended to delay or entirely prevent a vote on it. US President-elect Donald Trump said Wednesday that repealing and replacing the law should happen “essentially simultaneously.” However, neither he, nor the Republicans have yet presented a replacement program for Obamacare.

The Sneaky Republican Obamacare Strategy You Need to Know

The 2010 Affordable Care Act (ACA), or Obamacare, extended health insurance to around 20 million Americans, prevented insurers from denying coverage for pre-existing conditions, and provided states with billions of dollars for Medicaid health programs for the poor. Republicans pledged to scrap large parts of the law, however, citing rising health insurance premiums among other things. It was a promise that may have helped Donald Trump win the election, as voters were upset when it was announced that Obamacare premiums were set to jump by 25 percent in 2017.

It will not be an easy job to remove Obamacare, however, as some portions of the law which got rid of pre-existing conditions and allowed children to remain covered by their parents’ insurance until age 26, are still very popular among Americans. Trump promised to keep those provisions unchanged.

Thursday’s Senate vote sets up special rules for the repeal vote – the GOP will be able to pass it through a process known as reconciliation, which would require a simple majority in the 100-member Senate, instead of the 60 votes required to move most legislation. That means Republicans, who have 52 seats, can pass repeal legislation without any cooperation from Democrats.

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Millions of US Citizens would Lose Health Insurance without Obamacare

Washington, Dec 13 (Prensa Latina) Some 52 million US citizens under 65 years old with pre-existing health problems could remain without health insurance if the health legislation known as Obamacare is eliminated, said a report today.

The Affordable Care Act bans insurance companies from rejecting people with pre-existing conditions, but if it is eliminated, the health insurance of those citizens would be jeopardized.

According to the Kaiser Family Foundation report, most of those 52 million US people have insurance through their employers or governmental programs like Medicaid, but if they lose it and try to apply for it, they could be denied a new plan.

The Hill online version said that insurance companies have long lists of issues for rejecting a policy, ranging from diabetes to sleep apnea and pregnancy.

The Foundation said that before the current legislation, promoted by President Barack Obama, 18 percent of those applying for insurance in individual markets were denied policy, and many did not even try to apply.

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Trump Eases Tone of Criticisms of Obamacare

U.S. President-elect Donald Trump on Sunday eased the tone of his criticisms of the so-called Obamacare, a healthcare program that he promised to eliminate and that he is proposing to improve now.

The New York tycoon told The Wall Street Journal that he will work on the Accessible Care Act boosted by President Barack Obama, a program that Trump considers too expensive to be implemented.

However, the future president assured that he would seek in the Act the regulations that are worth implementing, including the protection of people affected by some conditions who do not have access to health insurance.

Trump admitted that President Obama urged him to think about it when they met on Thursday, after his victory in the elections over Democratic candidate Hillary Clinton, who would continue Obama's social policies.

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With Trump as president & Republican Congress, 22mn people could lose health insurance

The Republican victory, giving candidate Donald Trump the keys to the White House and with the party itself retaining dominance in Congress, could become a death-blow for Obamacare. Some 22 million people could lose their health insurance.

Both Trump and the Republicans en masse have repeatedly slammed the current healthcare system, Barack Obama’s signature Obamacare (Patient Protection and Affordable Care Act). For six years now they have been making calls for the act to be repealed, but so far only managed to pass several bills amending it.

The criticism skyrocketed two weeks ago when the Obama administration announced that  premiums will be further increased next year, while the choice of insurers will be cut by half.

Now it could all change, and soon, experts say.

They have a death blow to the Obamacare health coverage expansion,” John McDonough, a Harvard University professor who worked in the Senate on the passage of the Affordable Care Act  Vox news outlet. 

Under Obamacare, the government requires most people to have health insurance, provides subsidies of billions of dollars in premiums, and imposes fines for those uninsured. It was passed in 2010 aiming to lower the cost of healthcare and make it more affordable for lower-income Americans. But the faults that surfaced in the system once it came into law have sparked a lot of criticism, with Republicans having dubbed it “dishonest.”

Any honest agenda for improving healthcare must start with repeal of the dishonestly named Affordable Care Act of 2010: Obamacare. It weighs like the dead hand of the past upon American medicine. It imposed a Euro-style bureaucracy to manage its unworkable, budget-busting, conflicting provisions. It has driven up prices for all consumers […] It drove up drug prices […] It must be removed and replaced with an approach based on genuine competition, patient choice, excellent care, wellness, and timely access to treatment,” the GOP platform , promising further to repeal the system if a Republican enters the Oval Office.

To that end, a Republican president, on the first day in office, will use legitimate waiver authority under the law to halt its advance and then, with the unanimous support of Congressional Republicans, will sign its repeal.

Trump himself has  repeatedly that repealing Obamacare, which he called a “complete disaster,” would be his first act in office.

If we don't repeal and replace Obamacare, we will destroy American health care forever,” Trump said at a rally in Pennsylvania last week.

Outlining plans for his first 100 days in the White House a week before the election, he also swore to replace it with a health savings accounts program.

On Day One of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare,” Trump’s website states.

However, the Congressional Budget Office estimates that if this happens, 22 million people would lose their health insurance, mostly the people who had attained coverage for the first time as the law cancelled pre-existing conditions and expanded Medicaid to cover more low-income Americans. Especially as Trump himself does not have a healthcare platform to replace Obamacare with.

Practically, you can’t turn everything off immediately,” Chris Condeluci, tax and benefits counselor for the Senate Finance Committee's Republicans during the Affordable Care Act debate, told Vox. “The GOP doesn’t want to get beat up over kicking 20 million people off of insurance.”

To avoid this “beating,” in 2015 the Republicans drafted bill HR 3762 that would make the transition from Obamacare to another system smoother. The bill would repeal Obamacare’s tax credits for low- and middle-income Americans to purchase insurance by the end of 2017 and end the system’s Medicaid expansion, which will automatically create a two-year transition period, when Americans would still be able to enjoy health insurance coverage and authorities would be able to consider options to replace Obamacare. The problem, experts say, is that there is no alternative to replace it quickly.

“I don’t think the two [repeal and replace] would come in tandem,” Condeluci stated. “Replace needs to be litigated to a greater degree than it has before.”

The Republicans did  a document outlining their Obamacare replacement plan this summer, which envisions a number of health policy proposals. But it is not in legislative form.

I would envision Trump looking to Congress to drive the replace process, just as the Obama administration did with the Affordable Care Act,” Condeluci said.

I am going to take care of everybody,” Trump  in an interview to CBS’ 60 Minutes last year. “I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

With no replacement plan to speak of, however, critics doubt whether Trump’s administration will stick to its promise.

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