Different Takes On The GOP’s Latest Health Plan; A Status Report On The ACA

The Washington Post: Trumpcare 2.0 Won’t Go Anywhere, Either
The GOP 2.0 version of the American Health Care Act has about as much appeal as the original AHCA, or maybe less. It’s still a big tax cut for the rich, a hit to pocketbooks of older and more rural voters, and less generous than what recipients had received under Obamacare. Would a moderate in a district Hillary Clinton carried overwhelmingly go for this? It’d be a high-risk proposition. (Jennifer Rubin, 4/20)

Bloomberg: Republican Health-Care Policy: Trial And Error 
The current plan is apparently not to get rid of “Essential Health Benefits,” (a big talking point for the conservative part of the coalition), but instead to use waivers that would give states broad latitude to pare them back, if they wanted to. (Very sick people, whose insurance bills might spike under this scenario, are to be taken care of via “high-risk pools,” a remedy which liberals say is inadequate, because premiums in those pools can be quite high if they’re underfunded.) This is no way to build a health-care plan. (Megan McArdle, 4/20)

The Washington Post: The GOP’s Latest Health-Care Plan Is Comically Bad
House Republicans are apparently ready for yet another attempt to snatch health insurance away from constituents who need it. Someone should remind Speaker Paul Ryan of a saying often attributed to his legendary predecessor Sam Rayburn: “There’s no education in the second kick of the mule.” (Eugene Robinson, 4/20)

The New York Times: A New G.O.P. Health Proposal Evokes The Old Days
In the days before Obamacare, applying for health insurance meant filling out dozens of pages of forms and submitting medical records. It was almost impossible to compare prices. Your premium might be set higher for a large number of reasons, including if your child was overweight. This could be the future in some states under the latest Republican proposal to overhaul the health law. (Margot Sanger-Katz, 4/20)

The New York Times: The Balloon, The Box And Health Care
Imagine a man who for some reason is determined to stuff a balloon into a box — a box that, aside from being the wrong shape, just isn’t big enough. He starts working at one corner, pushing the balloon into position. But then he realizes that the air he’s squeezed out at one end has caused the balloon to expand elsewhere. So he tries at the opposite corner, but this undoes his original work. If he’s stupid or obsessive enough, he can spend a long time at this exercise. ... Now you understand what’s happening to G.O.P. efforts to repeal and replace the Affordable Care Act. (Paul Krugman, 4/21)

Vox: The GOP’s Biggest Health Care Achievement Has Been Making Obamacare More Popular
It is bizarre watching House Republicans persuade themselves that the problem they face on health care is cutting a deal between the Freedom Caucus and the Tuesday Group rather than crafting legislation that people actually like, and that will actually make some part of the health care system noticeably better. But the GOP’s refusal to take public opinion even mildly into account has put them in a disastrous position. (Ezra Klein, 4/20)

JAMA Forum: Is The Affordable Care Act Imploding?
Insurers have to make initial decisions about whether they will participate in the marketplaces in 2018 and what premiums they will charge by June 21. Ambiguity over how the Trump administration will operate the program and what Congress may do could lead insurers to leave the marketplaces or raise premiums significantly as a hedge against the uncertainty. ... Widespread insurer exits—which could leave counties with no insurers and therefore no ability for people to obtain coverage or premium tax credits—would no doubt lead to finger pointing and debate about who is to blame: former President Obama and Democrats or President Trump and congressional Republicans. Kaiser Family Foundation polling suggests that President Trump and Republicans would get the short end of that stick, with 61% of Americans holding them responsible for any future ACA problems. (Larry Levitt, 4/17)

The New England Journal of Medicine: Good Riddance To Big Insurance Mergers
Eighteen months after four of the five largest U.S. health insurers announced multibillion-dollar merger deals, federal judges, siding with the Department of Justice (DOJ), have issued preliminary injunctions halting the two transactions. These decisions will cost the insurers: they spent over $2 billion trying to get the deals done, and the would-be acquirers are due to pay $2.85 billion in breakup fees — and possibly billions more in damages. Moreover, the parties’ conduct has further damaged the public’s view of the insurance industry. Having suffered similar defeats at the hands of the Federal Trade Commission (FTC), hospitals are enjoying a moment of revenge. But the decisions actually provide more precedent to support challenges of mergers between competitors in health care markets — whether payers or providers. (Leemore S. Dafny, 4/19)