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"content": "\u003cp>\u003cstrong>Updated at 3:36 p.m. ET\u003c/strong>\u003c/p>\n\u003cp>Sen. John McCain may, once again, be the savior of President Barack Obama's signature domestic achievement.\u003c/p>\n\u003cp>The Arizona Republican announced in a statement on Friday that he opposes the latest GOP legislation to dismantle the Affordable Care Act.\u003c/p>\n\u003cp>\"I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans and Democrats, and have not yet really tried,\" McCain said \u003ca href=\"https://www.mccain.senate.gov/public/index.cfm/press-releases?ID=1D7F89BB-FF93-41A5-85B8-C87E3CCCC4CE\">in a statement\u003c/a> posted on his website.\u003c/p>\n\u003cp>McCain now joins Sen. Rand Paul, R-Ky., as one of two Republican \"no\" votes on the bill. Republicans cannot lose any additional senators and still pass the legislation with 50 votes and Vice President Pence acting as the tiebreaker.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One of the bill's sponsors, Sen. Lindsey Graham, R-S.C., is McCain's closest friend in the Senate, and said that \"is not based on how he votes but respect for how he's lived his life and the person he is.\" Graham also vowed to \"press on\" with his legislation.\u003c/p>\n\u003cp>https://twitter.com/LindseyGrahamSC/status/911307126190100480\u003c/p>\n\u003cp>Senate Democratic leader Chuck Schumer said in a statement: \"John McCain shows the same courage in Congress that he showed when he was a naval aviator. I have assured Senator McCain that as soon as repeal is off the table, we Democrats are intent on resuming the bipartisan process.\" An effort by GOP Sen. Lamar Alexander and Democratic Sen. Patty Murray, who lead the Senate Health, Education, Labor and Pensions Committee, has been put on hold since the Graham-Cassidy bill emerged. \u003c/p>\n\u003cp>The focus now shifts to two female GOP moderates, Sens. Lisa Murkowski of Alaska and Susan Collins of Maine, who joined McCain in ending the last GOP repeal bill in July.\u003c/p>\n\u003cp>[contextly_sidebar id=\"k6IdP0G7ZjRpfwFnv6S9d7cVHyBE0ksN\"]\u003c/p>\n\u003cp>Collins is widely believed to be opposed to Graham-Cassidy, as she has voted against all previous versions of GOP repeal bills, but she has not yet made her position on this bill public. She has, however, criticized Graham-Cassidy and echoed McCain's calls for bipartisan efforts to address health care concerns. At an event in Portland, Maine, on Friday morning, she said she was \"leaning against the bill,\" according to the \u003ca href=\"http://www.pressherald.com/2017/09/22/collins-says-shes-leaning-against-voting-for-graham-cassidy-health-care-bill/\">Portland Press Herald\u003c/a>. \u003c/p>\n\u003cp>Likewise, Murkowski voted against the previous GOP health care bills and has not yet declared her position. The Trump administration and GOP Senate leaders have been in ongoing negotiations to try to win her vote.\u003c/p>\n\u003cp>If one of the two senators announces opposition to the latest bill, it cannot pass the Senate. GOP leaders have said this is the last attempt they will make to repeal Obamacare ahead of the Sept. 30 deadline, when special budget rules expire that allow Republicans to pass a bill with just 50 votes.\u003c/p>\n\u003cp>The bill, authored by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, is the most far-reaching GOP proposal to date to undo Obamacare. The bill repeals key pillars of the law, such as the individual mandate; loosens its federal regulations, like those affecting pre-existing conditions; and fundamentally overhauls Medicaid, changing it from an open-ended federal guarantee to a program of capped funding directly to the states.\u003c/p>\n\u003cp>McCain said his opposition is not based on the substance of the bill but rather how it was put together. \"I would consider supporting legislation similar to that offered by my friends Senators Graham and Cassidy were it the product of extensive hearings, debate and amendment. But that has not been the case,\" he said.\u003c/p>\n\u003cp>McCain cast the decisive vote back in July that derailed an earlier version of the party's health care bill. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>Senate Democratic leader Chuck Schumer said in a statement: \"John McCain shows the same courage in Congress that he showed when he was a naval aviator. I have assured Senator McCain that as soon as repeal is off the table, we Democrats are intent on resuming the bipartisan process.\" An effort by GOP Sen. Lamar Alexander and Democratic Sen. Patty Murray, who lead the Senate Health, Education, Labor and Pensions Committee, has been put on hold since the Graham-Cassidy bill emerged. \u003c/p>\n\u003cp>The focus now shifts to two female GOP moderates, Sens. Lisa Murkowski of Alaska and Susan Collins of Maine, who joined McCain in ending the last GOP repeal bill in July.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Collins is widely believed to be opposed to Graham-Cassidy, as she has voted against all previous versions of GOP repeal bills, but she has not yet made her position on this bill public. She has, however, criticized Graham-Cassidy and echoed McCain's calls for bipartisan efforts to address health care concerns. At an event in Portland, Maine, on Friday morning, she said she was \"leaning against the bill,\" according to the \u003ca href=\"http://www.pressherald.com/2017/09/22/collins-says-shes-leaning-against-voting-for-graham-cassidy-health-care-bill/\">Portland Press Herald\u003c/a>. \u003c/p>\n\u003cp>Likewise, Murkowski voted against the previous GOP health care bills and has not yet declared her position. The Trump administration and GOP Senate leaders have been in ongoing negotiations to try to win her vote.\u003c/p>\n\u003cp>If one of the two senators announces opposition to the latest bill, it cannot pass the Senate. GOP leaders have said this is the last attempt they will make to repeal Obamacare ahead of the Sept. 30 deadline, when special budget rules expire that allow Republicans to pass a bill with just 50 votes.\u003c/p>\n\u003cp>The bill, authored by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, is the most far-reaching GOP proposal to date to undo Obamacare. The bill repeals key pillars of the law, such as the individual mandate; loosens its federal regulations, like those affecting pre-existing conditions; and fundamentally overhauls Medicaid, changing it from an open-ended federal guarantee to a program of capped funding directly to the states.\u003c/p>\n\u003cp>McCain said his opposition is not based on the substance of the bill but rather how it was put together. \"I would consider supporting legislation similar to that offered by my friends Senators Graham and Cassidy were it the product of extensive hearings, debate and amendment. But that has not been the case,\" he said.\u003c/p>\n\u003cp>McCain cast the decisive vote back in July that derailed an earlier version of the party's health care bill. His vote came just days after he was diagnosed with a severe form of brain cancer, for which he is undergoing chemotherapy and radiation treatments at the National Institutes of Health.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Paul's opposition to the bill is based on the Kentucky Republican's belief that it does not truly repeal the Affordable Care Act. \"I won't vote for Obamacare Lite that keeps 90% of the taxes & spending just so some people can claim credit for something that didn't happen,\" Paul tweeted on Friday. Under pressure from Trump and other Republicans to change his mind, Paul added, \"I won't be bribed or bullied.\" \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=McCain+Announces+Opposition+To+Obamacare+Repeal+Bill%2C+Possibly+Dooming+It&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>If President Trump decides to cut off payments to insurance companies called for under the Affordable Care Act, it's going to cost him.\u003c/p>\n\u003cp>Or, more accurately, it's going to cost taxpayers — about $194 billion over 10 years.\u003c/p>\n\u003cp>The cost is \"eye-poppingly large,\" says \u003ca href=\"https://www.law.umich.edu/FacultyBio/Pages/FacultyBio.aspx?FacID=nbagley\" target=\"_blank\" rel=\"noopener noreferrer\">Nicholas Bagley\u003c/a>, a professor of health law at the University of Michigan. \"This single policy could effectively end up costing 20 percent of the entire bill of the ACA.\"\u003c/p>\n\u003cp>The deficit figure comes from the Congressional Budget Office, which on Tuesday released an \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/reports/53009-costsharingreductions.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">estimate\u003c/a> of the budget impact of ending what's known as cost-sharing reduction payments. Those are payments the federal government makes to insurance companies to reimburse them for the discounts on copays and deductibles that they're required by law to give to low-income customers.\u003c/p>\n\u003cp>The reports also say premiums for benchmark plans sold on the Affordable Care Act exchanges will rise about 20 percent next year and about 25 percent by 2020. The cost to consumers, however, would stay the same or even decline, because the premium increases would be offset by tax credits, which we explain further below.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>President Trump threatened repeatedly to cut off the payments, which he's called \"bailouts,\" during the unsuccessful effort by Senate Republicans to repeal and replace the Affordable Care Act, or Obamacare.\u003c/p>\n\u003cp>More recently, the president has remained mute on the topic, and insurers have been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/08/01/540656651/trumps-tweets-threaten-to-destabilize-insurance-markets\" target=\"_blank\" rel=\"noopener noreferrer\">left to wonder\u003c/a> whether they will receive a check this month for the discounts they paid out in July.\u003c/p>\n\u003cp>Bagley says there's no good policy reason to cut off the payments. \"If you can cover roughly the same number of people for about $200 billion less, why wouldn't you want to do that?\" he asks.\u003c/p>\n\u003cp>Cutting the cost-sharing payments ends up costing the government more because insurance companies say they will raise rates in response. Under the Affordable Care Act, people with lower incomes who buy insurance on the exchanges get a tax credit, so their costs remain stable as a share of their income. That means that when premiums rise, those government subsidies rise as well.\u003c/p>\n\u003cp>The CBO says for people with incomes below 200 percent of the federal poverty level, the out-of-pocket cost of insurance would remain about the same because of the bigger tax credits. For those with incomes between 200 and 400 percent of the federal poverty level, the cost to buy insurance could actually get cheaper.\u003c/p>\n\u003cp>Last year, about \u003ca href=\"https://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2016-fact-sheets-items/2016-06-30.html\" target=\"_blank\" rel=\"noopener noreferrer\">85 percent\u003c/a> of people who bought Obamacare insurance got a tax credit, according to the Centers for Medicare and Medicaid Services.\u003c/p>\n\u003cp>\"The CBO analysis makes clear that ending cost-sharing subsidies would be a perfect example of cutting off your nose to spite your face,\" says \u003ca href=\"http://www.kff.org/person/larry-levitt/\" target=\"_blank\" rel=\"noopener noreferrer\">Larry Levitt\u003c/a>, a vice president at the Kaiser Family Foundation. \"Premiums would rise, and the government would end up spending more in the end through tax credits that help people pay their premiums.\"\u003c/p>\n\u003cp>The CBO report confirms earlier analyses, including \u003ca href=\"http://www.kff.org/health-reform/issue-brief/the-effects-of-ending-the-affordable-care-acts-cost-sharing-reduction-payments/\">this one\u003c/a> by Kaiser and \u003ca href=\"http://health.oliverwyman.com/transform-care/2017/05/impact_defunding_CSR_payments.html\" target=\"_blank\" rel=\"noopener noreferrer\">this one\u003c/a> from the consulting firm Oliver Wyman, that suggested eliminating the cost-sharing payments could make policies \u003ca href=\"http://www.npr.org/sections/health-shots/2017/05/16/528584408/trump-refusal-to-bail-out-insurers-might-end-up-making-policies-cheaper\" target=\"_blank\" rel=\"noopener noreferrer\">cheaper\u003c/a> for some individuals.\u003c/p>\n\u003cp>Some insurers may decide to leave the ACA markets altogether if the subsidies were to disappear \"because of the substantial uncertainty about the effects of the policy on average health care costs,\" the CBO says. The agency estimates about 5 percent of the population would not have access to insurance through the ACA markets next year if Trump ends the payments.\u003c/p>\n\u003cp>But the agency says insurers would come back over the next two years.\u003c/p>\n\u003cp>\u003ca href=\"https://law.wlu.edu/faculty/emeritus-faculty/tim-jost\" target=\"_blank\" rel=\"noopener noreferrer\">Timothy Jost\u003c/a>, a professor emeritus of health care law at Washington and Lee University School of Law, says that picture may be a bit too rosy.\u003c/p>\n\u003cp>He says the CBO assumes that state insurance commissioners will allow insurance companies to set premiums in ways that would be most advantageous to them, thereby ensuring they continue to sell policies on the Obamacare exchanges. But that may not happen, Yost warns.\u003c/p>\n\u003cp>\"CBO assumes that things will work out rationally, and there will be a smooth landing,\" he says. \"It could be much more chaotic than that.\"\u003c/p>\n\u003cp>Last Friday, the Department of Health and Human Services extended the deadline for insurance companies to decide what health plans to offer on the Obamacare exchanges and what to charge.\u003c/p>\n\u003cp>The cost-sharing payments have been at the center of a political battle over the Affordable Care Act since before President Trump took office.\u003c/p>\n\u003cp>House Republicans opposed to the health law sued then-President Barack Obama, saying the payments were illegal because Congress hadn't appropriated money for them. A judge agreed but allowed the administration to continue making the payments during an appeal.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Now that Trump is in the White House, and Republican efforts to repeal and replace the Affordable Care Act have failed, many Republicans are urging the president to continue the payments rather than undermine the health care markets.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=CBO+Predicts+Rise+In+Deficit+If+Trump+Cuts+Payments+To+Insurance+Companies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If President Trump decides to cut off payments to insurance companies called for under the Affordable Care Act, it's going to cost him.\u003c/p>\n\u003cp>Or, more accurately, it's going to cost taxpayers — about $194 billion over 10 years.\u003c/p>\n\u003cp>The cost is \"eye-poppingly large,\" says \u003ca href=\"https://www.law.umich.edu/FacultyBio/Pages/FacultyBio.aspx?FacID=nbagley\" target=\"_blank\" rel=\"noopener noreferrer\">Nicholas Bagley\u003c/a>, a professor of health law at the University of Michigan. \"This single policy could effectively end up costing 20 percent of the entire bill of the ACA.\"\u003c/p>\n\u003cp>The deficit figure comes from the Congressional Budget Office, which on Tuesday released an \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/reports/53009-costsharingreductions.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">estimate\u003c/a> of the budget impact of ending what's known as cost-sharing reduction payments. Those are payments the federal government makes to insurance companies to reimburse them for the discounts on copays and deductibles that they're required by law to give to low-income customers.\u003c/p>\n\u003cp>The reports also say premiums for benchmark plans sold on the Affordable Care Act exchanges will rise about 20 percent next year and about 25 percent by 2020. The cost to consumers, however, would stay the same or even decline, because the premium increases would be offset by tax credits, which we explain further below.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>President Trump threatened repeatedly to cut off the payments, which he's called \"bailouts,\" during the unsuccessful effort by Senate Republicans to repeal and replace the Affordable Care Act, or Obamacare.\u003c/p>\n\u003cp>More recently, the president has remained mute on the topic, and insurers have been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/08/01/540656651/trumps-tweets-threaten-to-destabilize-insurance-markets\" target=\"_blank\" rel=\"noopener noreferrer\">left to wonder\u003c/a> whether they will receive a check this month for the discounts they paid out in July.\u003c/p>\n\u003cp>Bagley says there's no good policy reason to cut off the payments. \"If you can cover roughly the same number of people for about $200 billion less, why wouldn't you want to do that?\" he asks.\u003c/p>\n\u003cp>Cutting the cost-sharing payments ends up costing the government more because insurance companies say they will raise rates in response. Under the Affordable Care Act, people with lower incomes who buy insurance on the exchanges get a tax credit, so their costs remain stable as a share of their income. That means that when premiums rise, those government subsidies rise as well.\u003c/p>\n\u003cp>The CBO says for people with incomes below 200 percent of the federal poverty level, the out-of-pocket cost of insurance would remain about the same because of the bigger tax credits. For those with incomes between 200 and 400 percent of the federal poverty level, the cost to buy insurance could actually get cheaper.\u003c/p>\n\u003cp>Last year, about \u003ca href=\"https://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2016-fact-sheets-items/2016-06-30.html\" target=\"_blank\" rel=\"noopener noreferrer\">85 percent\u003c/a> of people who bought Obamacare insurance got a tax credit, according to the Centers for Medicare and Medicaid Services.\u003c/p>\n\u003cp>\"The CBO analysis makes clear that ending cost-sharing subsidies would be a perfect example of cutting off your nose to spite your face,\" says \u003ca href=\"http://www.kff.org/person/larry-levitt/\" target=\"_blank\" rel=\"noopener noreferrer\">Larry Levitt\u003c/a>, a vice president at the Kaiser Family Foundation. \"Premiums would rise, and the government would end up spending more in the end through tax credits that help people pay their premiums.\"\u003c/p>\n\u003cp>The CBO report confirms earlier analyses, including \u003ca href=\"http://www.kff.org/health-reform/issue-brief/the-effects-of-ending-the-affordable-care-acts-cost-sharing-reduction-payments/\">this one\u003c/a> by Kaiser and \u003ca href=\"http://health.oliverwyman.com/transform-care/2017/05/impact_defunding_CSR_payments.html\" target=\"_blank\" rel=\"noopener noreferrer\">this one\u003c/a> from the consulting firm Oliver Wyman, that suggested eliminating the cost-sharing payments could make policies \u003ca href=\"http://www.npr.org/sections/health-shots/2017/05/16/528584408/trump-refusal-to-bail-out-insurers-might-end-up-making-policies-cheaper\" target=\"_blank\" rel=\"noopener noreferrer\">cheaper\u003c/a> for some individuals.\u003c/p>\n\u003cp>Some insurers may decide to leave the ACA markets altogether if the subsidies were to disappear \"because of the substantial uncertainty about the effects of the policy on average health care costs,\" the CBO says. The agency estimates about 5 percent of the population would not have access to insurance through the ACA markets next year if Trump ends the payments.\u003c/p>\n\u003cp>But the agency says insurers would come back over the next two years.\u003c/p>\n\u003cp>\u003ca href=\"https://law.wlu.edu/faculty/emeritus-faculty/tim-jost\" target=\"_blank\" rel=\"noopener noreferrer\">Timothy Jost\u003c/a>, a professor emeritus of health care law at Washington and Lee University School of Law, says that picture may be a bit too rosy.\u003c/p>\n\u003cp>He says the CBO assumes that state insurance commissioners will allow insurance companies to set premiums in ways that would be most advantageous to them, thereby ensuring they continue to sell policies on the Obamacare exchanges. But that may not happen, Yost warns.\u003c/p>\n\u003cp>\"CBO assumes that things will work out rationally, and there will be a smooth landing,\" he says. \"It could be much more chaotic than that.\"\u003c/p>\n\u003cp>Last Friday, the Department of Health and Human Services extended the deadline for insurance companies to decide what health plans to offer on the Obamacare exchanges and what to charge.\u003c/p>\n\u003cp>The cost-sharing payments have been at the center of a political battle over the Affordable Care Act since before President Trump took office.\u003c/p>\n\u003cp>House Republicans opposed to the health law sued then-President Barack Obama, saying the payments were illegal because Congress hadn't appropriated money for them. A judge agreed but allowed the administration to continue making the payments during an appeal.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Now that Trump is in the White House, and Republican efforts to repeal and replace the Affordable Care Act have failed, many Republicans are urging the president to continue the payments rather than undermine the health care markets.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=CBO+Predicts+Rise+In+Deficit+If+Trump+Cuts+Payments+To+Insurance+Companies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In a moment of unexpected high drama, Republicans were stymied once again in their effort to repeal the Affordable Care Act — and they have John McCain to thank for it.\u003c/p>\n\u003cp>In the early morning hours Friday, the senator showed why he earned the nickname \"Maverick\" over his long tenure.\u003c/p>\n\u003cp>McCain, who was diagnosed with brain cancer and returned to Washington to advance the health care bill, turned around and bucked his party's leadership — and President Trump — by joining two moderate Republicans, two independents and every Democrat in voting against the so-called skinny repeal of the Affordable Care Act, also known as Obamacare.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=DWeayFHsH90\u003c/p>\n\u003cp>McCain's office released a statement from the senator on his reasoning:\u003c/p>\n\u003cblockquote>\u003cp>\"From the beginning, I have believed that Obamacare should be repealed and replaced with a solution that increases competition, lowers costs, and improves care for the American people. The so-called 'skinny repeal' amendment the Senate voted on today would not accomplish those goals. While the amendment would have repealed some of Obamacare's most burdensome regulations, it offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens. The Speaker's statement that the House would be 'willing' to go to conference does not ease my concern that this shell of a bill could be taken up and passed at any time.\"\u003c/p>\u003c/blockquote>\n\u003cp>McCain continued, calling on lawmakers to \"return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation's governors, and produce a bill that finally delivers affordable health care for the American people.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The Senate voted 51-49 against the legislation aimed at dismantling the Affordable Care Act.\u003c/p>\n\u003cp>\"This is clearly a disappointing moment,\" Republican Senate leader Mitch McConnell of Kentucky said immediately after the bill failed. He added, \"I regret that our efforts simply were not enough this time.\"\u003c/p>\n\u003cp>McConnell, who seemed to exhaust every trick in the procedural playbook to get to this point, seemed surprised and undercut by the result.\u003c/p>\n\u003cp>The defeat ends — for now — the health care debate in Congress. The chamber adjourned following the defeat, and there are no further Senate votes this week. In the short term, the Senate intends to move on to defense legislation and the nomination of Christopher Wray to be the next FBI director.\u003c/p>\n\u003cp>In a written statement from McConnell's office after the vote, he seemed to indicate a GOP-only effort on health care may be dead.\u003c/p>\n\u003cp>\"We look forward to our colleagues on the other side suggesting what they have in mind,\" McConnell said in the statement.\u003c/p>\n\u003cp>Republican senators said there was no consensus and no plan for what comes next on health care. Sen. Ted Cruz, R-Texas, warned of potentially severe political consequences for Republicans for failing to deliver on what has been the GOP's unifying campaign pledge for the previous three elections.\u003c/p>\n\u003cp>\"I sadly feel a great many Americans will feel betrayed,\" Cruz told reporters, \"that they were lied to, and that sentiment will not be unjustified.\"\u003c/p>\n\u003cp>The \"skinny repeal\" was a pared-down version of Republican proposals to undo Obamacare with no plan for what to replace it with. It would have eliminated the individual and employer mandate and key taxes, defunded Planned Parenthood for a year and eliminated key protections of health benefits that were required under Obamacare.\u003c/p>\n\u003cp>The bill was deeply unpopular, but GOP leaders worked to assure members it would never become law. Instead, they wanted the Senate to pass it in order to advance the legislation to a third round of negotiations with the House to try to craft a final bill both chambers could pass.\u003c/p>\n\u003cp>McCain was not moved by these assurances, including a private meeting with House Speaker Paul Ryan on Thursday prior to the Senate vote. After the vote, McCain quickly left the Capitol and declined to comment to reporters.\u003c/p>\n\u003cp>Something seemed afoot before the vote. It was delayed. McCain was seen huddling with Democrats. Vice President Mike Pence, who had come to the Capitol expecting to be the tie-breaking vote, personally — and unsuccessfully — lobbied McCain on the floor to try to win his vote.\u003c/p>\n\u003cp>With McCain's vote apparently gone, Republicans were seen trying to persuade Alaska's Lisa Murkowski to vote for the bill — to no avail. She eventually also voted no (as originally expected) along with Maine's Susan Collins.\u003c/p>\n\u003cp>Some GOP senators worried the measure would go back to the House, where leaders would put it on the floor, pass it and send it to Trump — who has said he would sign whatever lands on his desk when it comes to Republican-passed health care legislation.\u003c/p>\n\u003cp>Before the vote, at 10:43 p.m. ET, Trump was rooting them on in a tweet: \"Go Republican Senators. Go!\"\u003c/p>\n\u003cp>https://twitter.com/realDonaldTrump/status/890764622852173826\u003c/p>\n\u003cp>Afterward, it was a different story, with the president tweeting at 2:25 a.m. ET that those who voted no had \"let the American people down.\"\u003c/p>\n\u003cp>https://twitter.com/realDonaldTrump/status/890820505330212864\u003c/p>\n\u003cp>It's somewhat ironic that McCain was the one to derail what seemed like a sure Trump victory (even if only a short-term one). After all, Trump's comments about the former prisoner of war were among the earliest to land the then-candidate in controversy.\u003c/p>\n\u003cp>\"He's not a war hero,\" Trump said in 2015 of McCain. \"He was a war hero, because he was captured. I like people who weren't captured. He's been losing so long he doesn't know how to win anymore.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That was likely never lost on McCain.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=McCain+Votes+No%2C+Dealing+Potential+Death+Blow+To+Republican+Health+Care+Efforts&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a moment of unexpected high drama, Republicans were stymied once again in their effort to repeal the Affordable Care Act — and they have John McCain to thank for it.\u003c/p>\n\u003cp>In the early morning hours Friday, the senator showed why he earned the nickname \"Maverick\" over his long tenure.\u003c/p>\n\u003cp>McCain, who was diagnosed with brain cancer and returned to Washington to advance the health care bill, turned around and bucked his party's leadership — and President Trump — by joining two moderate Republicans, two independents and every Democrat in voting against the so-called skinny repeal of the Affordable Care Act, also known as Obamacare.\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/DWeayFHsH90'\n title='//www.youtube.com/embed/DWeayFHsH90'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>McCain's office released a statement from the senator on his reasoning:\u003c/p>\n\u003cblockquote>\u003cp>\"From the beginning, I have believed that Obamacare should be repealed and replaced with a solution that increases competition, lowers costs, and improves care for the American people. The so-called 'skinny repeal' amendment the Senate voted on today would not accomplish those goals. While the amendment would have repealed some of Obamacare's most burdensome regulations, it offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens. The Speaker's statement that the House would be 'willing' to go to conference does not ease my concern that this shell of a bill could be taken up and passed at any time.\"\u003c/p>\u003c/blockquote>\n\u003cp>McCain continued, calling on lawmakers to \"return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation's governors, and produce a bill that finally delivers affordable health care for the American people.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Senate voted 51-49 against the legislation aimed at dismantling the Affordable Care Act.\u003c/p>\n\u003cp>\"This is clearly a disappointing moment,\" Republican Senate leader Mitch McConnell of Kentucky said immediately after the bill failed. He added, \"I regret that our efforts simply were not enough this time.\"\u003c/p>\n\u003cp>McConnell, who seemed to exhaust every trick in the procedural playbook to get to this point, seemed surprised and undercut by the result.\u003c/p>\n\u003cp>The defeat ends — for now — the health care debate in Congress. The chamber adjourned following the defeat, and there are no further Senate votes this week. In the short term, the Senate intends to move on to defense legislation and the nomination of Christopher Wray to be the next FBI director.\u003c/p>\n\u003cp>In a written statement from McConnell's office after the vote, he seemed to indicate a GOP-only effort on health care may be dead.\u003c/p>\n\u003cp>\"We look forward to our colleagues on the other side suggesting what they have in mind,\" McConnell said in the statement.\u003c/p>\n\u003cp>Republican senators said there was no consensus and no plan for what comes next on health care. Sen. Ted Cruz, R-Texas, warned of potentially severe political consequences for Republicans for failing to deliver on what has been the GOP's unifying campaign pledge for the previous three elections.\u003c/p>\n\u003cp>\"I sadly feel a great many Americans will feel betrayed,\" Cruz told reporters, \"that they were lied to, and that sentiment will not be unjustified.\"\u003c/p>\n\u003cp>The \"skinny repeal\" was a pared-down version of Republican proposals to undo Obamacare with no plan for what to replace it with. It would have eliminated the individual and employer mandate and key taxes, defunded Planned Parenthood for a year and eliminated key protections of health benefits that were required under Obamacare.\u003c/p>\n\u003cp>The bill was deeply unpopular, but GOP leaders worked to assure members it would never become law. Instead, they wanted the Senate to pass it in order to advance the legislation to a third round of negotiations with the House to try to craft a final bill both chambers could pass.\u003c/p>\n\u003cp>McCain was not moved by these assurances, including a private meeting with House Speaker Paul Ryan on Thursday prior to the Senate vote. After the vote, McCain quickly left the Capitol and declined to comment to reporters.\u003c/p>\n\u003cp>Something seemed afoot before the vote. It was delayed. McCain was seen huddling with Democrats. Vice President Mike Pence, who had come to the Capitol expecting to be the tie-breaking vote, personally — and unsuccessfully — lobbied McCain on the floor to try to win his vote.\u003c/p>\n\u003cp>With McCain's vote apparently gone, Republicans were seen trying to persuade Alaska's Lisa Murkowski to vote for the bill — to no avail. She eventually also voted no (as originally expected) along with Maine's Susan Collins.\u003c/p>\n\u003cp>Some GOP senators worried the measure would go back to the House, where leaders would put it on the floor, pass it and send it to Trump — who has said he would sign whatever lands on his desk when it comes to Republican-passed health care legislation.\u003c/p>\n\u003cp>Before the vote, at 10:43 p.m. ET, Trump was rooting them on in a tweet: \"Go Republican Senators. Go!\"\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>Afterward, it was a different story, with the president tweeting at 2:25 a.m. ET that those who voted no had \"let the American people down.\"\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>It's somewhat ironic that McCain was the one to derail what seemed like a sure Trump victory (even if only a short-term one). After all, Trump's comments about the former prisoner of war were among the earliest to land the then-candidate in controversy.\u003c/p>\n\u003cp>\"He's not a war hero,\" Trump said in 2015 of McCain. \"He was a war hero, because he was captured. I like people who weren't captured. He's been losing so long he doesn't know how to win anymore.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That was likely never lost on McCain.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=McCain+Votes+No%2C+Dealing+Potential+Death+Blow+To+Republican+Health+Care+Efforts&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Senate Republicans have cast two separate votes this week trying to dismantle the Affordable Care Act. The first bill to be voted down was a “repeal-only” proposal and the second was a plan for replacement.\u003c/p>\n\u003cp>With their options narrowed, Senate Republicans are now trying to remove some key provisions of Obamacare in what’s being called the “skinny repeal.”\u003c/p>\n\u003cp>The language is not yet final, but one version of the repeal bill would remove the requirement for individuals and businesses to buy health insurance. This is a key feature that works to expand risk pools and lower costs. The GOP plan would also get rid of the medical device tax — a revenue source for the current health law.\u003c/p>\n\u003cp>But what does this all mean for California?\u003c/p>\n\u003cp>“The implications for 2018 are stark,” said Peter V. Lee in a statement Thursday. He’s the executive director of Covered California, the state’s health insurance marketplace. About 700,000 fewer Californians would have individual coverage, he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=”jK8MqzTl6jlFnyIrRhm5pDjP5YI9ZqOa”]\u003c/p>\n\u003cp>“Many of those people would drop coverage not because there is no penalty but because the increase in premiums could be as much as 20 percent more due to a less healthy risk mix,” Lee said in the statement.\u003c/p>\n\u003cp>Apart from those coverage losses in the individual market, 300,000 Californians would likely not enroll in Medicaid due to the elimination of the individual mandate, the group said, noting its analysis was consistent with prior \u003ca href=\"http://board.coveredca.com/meetings/2016/5-12/Covered%20CA%20and%20PwC%20Market%20Planning%20and%20Analysis_Board%20Draft.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">estimates\u003c/a> of the elimination of the mandate developed for it by PricewaterhouseCoopers.\u003c/p>\n\u003cp>In short, Covered California said the “skinny repeal” would lead to increases in uncompensated care that would have implications for the entire state.\u003c/p>\n\u003cp>Sen. Dianne Feinstein, citing the group’s findings, said Thursday she was concerned the Republican bill would “take California backward in terms of coverage gains achieved over the last four years.”\u003c/p>\n\u003cp>The Senate is expected to debate the bill through late Thursday, following fast-track budget rules that limit the negotiations to 20 hours. But amendments can still be added.\u003c/p>\n\u003cp>When debate time expires, those amendments are voted on in what Senators call a “vote-a-rama.” This could turn into an all-night session tonight, where the Senate Republican definition of skinny could keep evolving.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California’s 55-member congressional delegation has split along party lines on the health care votes, with all 14 House Republicans supporting GOP legislation to roll back Obamacare and their Democratic counterparts, including the state’s two senators, remaining opposed to such efforts.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Senate Republicans have cast two separate votes this week trying to dismantle the Affordable Care Act. The first bill to be voted down was a “repeal-only” proposal and the second was a plan for replacement.\u003c/p>\n\u003cp>With their options narrowed, Senate Republicans are now trying to remove some key provisions of Obamacare in what’s being called the “skinny repeal.”\u003c/p>\n\u003cp>The language is not yet final, but one version of the repeal bill would remove the requirement for individuals and businesses to buy health insurance. This is a key feature that works to expand risk pools and lower costs. The GOP plan would also get rid of the medical device tax — a revenue source for the current health law.\u003c/p>\n\u003cp>But what does this all mean for California?\u003c/p>\n\u003cp>“The implications for 2018 are stark,” said Peter V. Lee in a statement Thursday. He’s the executive director of Covered California, the state’s health insurance marketplace. About 700,000 fewer Californians would have individual coverage, he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“Many of those people would drop coverage not because there is no penalty but because the increase in premiums could be as much as 20 percent more due to a less healthy risk mix,” Lee said in the statement.\u003c/p>\n\u003cp>Apart from those coverage losses in the individual market, 300,000 Californians would likely not enroll in Medicaid due to the elimination of the individual mandate, the group said, noting its analysis was consistent with prior \u003ca href=\"http://board.coveredca.com/meetings/2016/5-12/Covered%20CA%20and%20PwC%20Market%20Planning%20and%20Analysis_Board%20Draft.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">estimates\u003c/a> of the elimination of the mandate developed for it by PricewaterhouseCoopers.\u003c/p>\n\u003cp>In short, Covered California said the “skinny repeal” would lead to increases in uncompensated care that would have implications for the entire state.\u003c/p>\n\u003cp>Sen. Dianne Feinstein, citing the group’s findings, said Thursday she was concerned the Republican bill would “take California backward in terms of coverage gains achieved over the last four years.”\u003c/p>\n\u003cp>The Senate is expected to debate the bill through late Thursday, following fast-track budget rules that limit the negotiations to 20 hours. But amendments can still be added.\u003c/p>\n\u003cp>When debate time expires, those amendments are voted on in what Senators call a “vote-a-rama.” This could turn into an all-night session tonight, where the Senate Republican definition of skinny could keep evolving.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California’s 55-member congressional delegation has split along party lines on the health care votes, with all 14 House Republicans supporting GOP legislation to roll back Obamacare and their Democratic counterparts, including the state’s two senators, remaining opposed to such efforts.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "States Have Already Tried Versions of 'Skinny Repeal.' It Didn't Go Well",
"title": "States Have Already Tried Versions of 'Skinny Repeal.' It Didn't Go Well",
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"content": "\u003cp>Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a \"skinny repeal\" that would roll back an unpopular portion of the federal health law. But health policy analysts warn that the idea has been tried before, and with little success.\u003c/p>\n\u003cp>Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act's \"individual mandate,\" which assesses a tax on Americans who don't have insurance. The bill would also eliminate the ACA's penalties for some businesses -- those that have 50 or more workers and fail to offer their employees health coverage.\u003c/p>\n\u003cp>Details aren't clear, but it appears that — at least initially — much of the rest of the 2010 health law would remain, under this strategy, including the rule that says insurers must cover people who have pre-existing medical problems.\u003c/p>\n\u003cp>[contextly_sidebar id=\"3xCHRB83RCegO5eCE9I9b7XUGYrDBx2J\"]\u003c/p>\n\u003cp>In remarks on the Senate floor Wednesday, Sen. Minority Leader Charles Schumer, D-N.Y., said that \"we just heard from the nonpartisan Congressional Budget Office that under such a plan ... 16 million Americans would lose their health insurance, and millions more would pay a 20 percent increase in their premiums.\" The CBO \u003ca href=\"https://www.cbo.gov/publication/52977\" target=\"_blank\" rel=\"noopener noreferrer\">posted its evaluation\u003c/a> of the GOP's proposed plan Wednesday evening.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Earlier in the day, some Republicans seemed determined to find some way to keep the health care debate alive.\u003c/p>\n\u003cp>\"We need an outcome, and if a so-called skinny repeal is the first step, that's a good first step,\" said Sen. Thom Tillis, R-N.C.\u003c/p>\n\u003cp>Several Republican senators, including Dean Heller of Nevada and Jeff Flake of Arizona, appear to back this approach, according to \u003ca href=\"http://www.politico.com/story/2017/07/26/obamacare-repeal-republicans-minimum-240982\" target=\"_blank\" rel=\"noopener noreferrer\">published reports\u003c/a>. It is, at least for now, being viewed as a step along the way to Republican health reform.\u003c/p>\n\u003cp>\"I think that most people would understand that what you're really voting on is trying to keep the conversation alive,\" said Sen. Bob Corker, R-Tenn. \"It's not the policy itself ... it's about trying to create a bigger discussion about repeal between the House and Senate.\"\u003c/p>\n\u003cp>But what if, during these strange legislative times, the skinny repeal were to be passed by the Senate and then go on to become law? States' experiences with insurance market reforms and rollbacks highlight the possible trouble spots.\u003c/p>\n\u003ch3>Considering the Parallels\u003c/h3>\n\u003cp>By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash when some of the coverage requirement rules they'd previously put on the individual market were lifted. \"Things went badly,\" said \u003ca href=\"http://law.wfu.edu/faculty/profile/hallma/\" target=\"_blank\" rel=\"noopener noreferrer\">Mark Hall\u003c/a>, director of the health law and policy program at Wake Forest University.\u003c/p>\n\u003cp>Premiums rose and insurers fled these states, leaving consumers who buy their own coverage (usually because they don't get it through their jobs) with fewer choices and higher prices.\u003c/p>\n\u003cp>That's because — like the Senate plan — the states generally kept popular parts of their laws, including protections for people with pre-existing conditions. At the same time, they didn't include mandates that consumers carry coverage.\u003c/p>\n\u003cp>[contextly_sidebar id=\"uvPSgszQseNfQlpVIo48aD8k0r8xaCVy\"]\u003c/p>\n\u003cp>That goes to a basic concept about any kind of insurance: People who don't file claims in any given year subsidize those who do. Also, those healthy people are less likely to sign up, insurers said, and that leaves insurance companies with only the more costly policyholders.\u003c/p>\n\u003cp>Bottom line: Insurers end up \"less willing to participate in the market,\" said Hall.\u003c/p>\n\u003cp>It's not an exact comparison, though, he added, because the current federal health law offers something most states did not: significant subsidies to help some people buy coverage. Those subsidies could blunt the effect of not having a mandate.\u003c/p>\n\u003cp>During the debate that led to passage of the federal ACA, insurers flat-out said the plan would fail without an individual mandate. On Wednesday, the Blue Cross Blue Shield Association weighed in again, saying that if there is no longer a coverage requirement, there should be \"strong incentives for people to obtain health insurance and keep it year-round.\"\u003c/p>\n\u003ch3>Individual Mandate Is Still Unpopular in Voter Polls\u003c/h3>\n\u003cp>About 6.5 million Americans \u003ca href=\"http://www.cnbc.com/2017/01/11/fewer-people-paid-obamacare-tax-penalties-as-more-got-obamacare-aid.html\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> owing penalties for not having coverage in 2015.\u003c/p>\n\u003cp>Polls consistently show, though, that the individual mandate is unpopular with the public. Indeed, when asked about nine provisions in the ACA, registered voters in a recent Politico/Morning Consult \u003ca href=\"http://www.cnbc.com/2017/02/22/obamacare-getting-more-popular-with-voters-in-trumps-presidency-poll.html\">poll\u003c/a> said they want the Senate to keep eight, rejecting only the individual mandate.\u003c/p>\n\u003cp>Even though the mandate's penalty is often criticized as not strong enough, removing it would still affect the individual market.\u003c/p>\n\u003cp>\"Insurers would react conservatively and increase rates substantially to cover their risk,\" said insurance industry consultant \u003ca href=\"http://www.healthpol.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Robert Laszewski\u003c/a>.\u003c/p>\n\u003cp>That's what happened after Washington state lawmakers rolled back rules in 1995 legislation. Insurers requested significant rate increases, which were then rejected by the state's insurance commissioner. By 1998, the state's largest insurer — Premera Blue Cross — said it was losing so much money that it would stop selling new individual policies, \"precipitating a sense of crisis,\" according to a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/10804476\" target=\"_blank\" rel=\"noopener noreferrer\">published\u003c/a> in 2000 in the \u003cem>Journal of Health Politics, Policy and Law\u003c/em>.\u003c/p>\n\u003cp>\"When one pulled out, the others followed,\" said current Washington Insurance Commissioner \u003ca href=\"https://www.insurance.wa.gov/about-mike-kreidler\" target=\"_blank\" rel=\"noopener noreferrer\">Mike Kreidler\u003c/a>, who was then a regional director in the federal department of Health and Human Services.\u003c/p>\n\u003cp>The state's individual market was volatile and difficult for years after. Insurers did come back, but won a concession: For a time, the insurance commissioner lost the power to reject rate increases. Kreidler, first elected in 2000, reclaimed that authority.\u003c/p>\n\u003cp>Predicting the effect of removing the individual mandate is difficult, although Kreidler said he expects the impact would be modest, at least initially. Subsidies that help people purchase insurance coverage — if they remain as they are under current law — could help blunt the impact. But if those subsidies are reduced — or other changes are made that further drive healthy people out of the market — the impact could be greater.\u003c/p>\n\u003cp>\"Few markets can go bad on you as fast as a health insurance market,\" said Kreidler.\u003c/p>\n\u003cp>As for employers, dropping the requirement that those with 50 or more workers must offer health insurance or face a financial penalty could mean some workers would lose coverage. But their jobs might be more secure, said \u003ca href=\"http://www.aei.org/scholar/joseph-antos/\" target=\"_blank\" rel=\"noopener noreferrer\">Joseph Antos\u003c/a>, a health care economist and resident scholar at the American Enterprise Institute.\u003c/p>\n\u003cp>That's because the requirement under the ACA meant that some smaller firms didn't hire people or give workers more than 30 hours a week — the minimum needed under the ACA to be considered a full-time worker who qualified for health insurance.\u003c/p>\n\u003cp>The individual mandate, he added, may not be as much of a factor in getting people to enroll in coverage as some think, because the Trump administration has indicated it might not enforce it anyway — and the penalty amount is far less than most people would have to pay for health insurance.\u003c/p>\n\u003cp>However, the individual market could be roiled by other factors, Antos said.\u003c/p>\n\u003cp>\"The real impact would come if feds stopped promoting enrollment and did other things to make the exchanges the state and federal markets through which insurance is offered] work more poorly.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit health newsroom, an editorially independent part of the Kaiser Family Foundation. You can follow KHN senior correspondent Julie Appleby on Twitter \u003c/em>\u003ca href=\"http://twitter.com/Julie_Appleby\">\u003cem>\u003cstrong>@Julie_Appleby\u003c/strong>\u003c/em>\u003c/a>\u003cem> Congressional reporter \u003c/em>\u003ca href=\"https://twitter.com/RachelHBluth\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Rachel Bluth\u003c/em>\u003c/a>\u003cem> also contributed to this report. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=States+Have+Already+Tried+Versions+Of+%27Skinny+Repeal.%27+It+Didn%27t+Go+Well&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a \"skinny repeal\" that would roll back an unpopular portion of the federal health law. But health policy analysts warn that the idea has been tried before, and with little success.\u003c/p>\n\u003cp>Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act's \"individual mandate,\" which assesses a tax on Americans who don't have insurance. The bill would also eliminate the ACA's penalties for some businesses -- those that have 50 or more workers and fail to offer their employees health coverage.\u003c/p>\n\u003cp>Details aren't clear, but it appears that — at least initially — much of the rest of the 2010 health law would remain, under this strategy, including the rule that says insurers must cover people who have pre-existing medical problems.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In remarks on the Senate floor Wednesday, Sen. Minority Leader Charles Schumer, D-N.Y., said that \"we just heard from the nonpartisan Congressional Budget Office that under such a plan ... 16 million Americans would lose their health insurance, and millions more would pay a 20 percent increase in their premiums.\" The CBO \u003ca href=\"https://www.cbo.gov/publication/52977\" target=\"_blank\" rel=\"noopener noreferrer\">posted its evaluation\u003c/a> of the GOP's proposed plan Wednesday evening.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Earlier in the day, some Republicans seemed determined to find some way to keep the health care debate alive.\u003c/p>\n\u003cp>\"We need an outcome, and if a so-called skinny repeal is the first step, that's a good first step,\" said Sen. Thom Tillis, R-N.C.\u003c/p>\n\u003cp>Several Republican senators, including Dean Heller of Nevada and Jeff Flake of Arizona, appear to back this approach, according to \u003ca href=\"http://www.politico.com/story/2017/07/26/obamacare-repeal-republicans-minimum-240982\" target=\"_blank\" rel=\"noopener noreferrer\">published reports\u003c/a>. It is, at least for now, being viewed as a step along the way to Republican health reform.\u003c/p>\n\u003cp>\"I think that most people would understand that what you're really voting on is trying to keep the conversation alive,\" said Sen. Bob Corker, R-Tenn. \"It's not the policy itself ... it's about trying to create a bigger discussion about repeal between the House and Senate.\"\u003c/p>\n\u003cp>But what if, during these strange legislative times, the skinny repeal were to be passed by the Senate and then go on to become law? States' experiences with insurance market reforms and rollbacks highlight the possible trouble spots.\u003c/p>\n\u003ch3>Considering the Parallels\u003c/h3>\n\u003cp>By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash when some of the coverage requirement rules they'd previously put on the individual market were lifted. \"Things went badly,\" said \u003ca href=\"http://law.wfu.edu/faculty/profile/hallma/\" target=\"_blank\" rel=\"noopener noreferrer\">Mark Hall\u003c/a>, director of the health law and policy program at Wake Forest University.\u003c/p>\n\u003cp>Premiums rose and insurers fled these states, leaving consumers who buy their own coverage (usually because they don't get it through their jobs) with fewer choices and higher prices.\u003c/p>\n\u003cp>That's because — like the Senate plan — the states generally kept popular parts of their laws, including protections for people with pre-existing conditions. At the same time, they didn't include mandates that consumers carry coverage.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That goes to a basic concept about any kind of insurance: People who don't file claims in any given year subsidize those who do. Also, those healthy people are less likely to sign up, insurers said, and that leaves insurance companies with only the more costly policyholders.\u003c/p>\n\u003cp>Bottom line: Insurers end up \"less willing to participate in the market,\" said Hall.\u003c/p>\n\u003cp>It's not an exact comparison, though, he added, because the current federal health law offers something most states did not: significant subsidies to help some people buy coverage. Those subsidies could blunt the effect of not having a mandate.\u003c/p>\n\u003cp>During the debate that led to passage of the federal ACA, insurers flat-out said the plan would fail without an individual mandate. On Wednesday, the Blue Cross Blue Shield Association weighed in again, saying that if there is no longer a coverage requirement, there should be \"strong incentives for people to obtain health insurance and keep it year-round.\"\u003c/p>\n\u003ch3>Individual Mandate Is Still Unpopular in Voter Polls\u003c/h3>\n\u003cp>About 6.5 million Americans \u003ca href=\"http://www.cnbc.com/2017/01/11/fewer-people-paid-obamacare-tax-penalties-as-more-got-obamacare-aid.html\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> owing penalties for not having coverage in 2015.\u003c/p>\n\u003cp>Polls consistently show, though, that the individual mandate is unpopular with the public. Indeed, when asked about nine provisions in the ACA, registered voters in a recent Politico/Morning Consult \u003ca href=\"http://www.cnbc.com/2017/02/22/obamacare-getting-more-popular-with-voters-in-trumps-presidency-poll.html\">poll\u003c/a> said they want the Senate to keep eight, rejecting only the individual mandate.\u003c/p>\n\u003cp>Even though the mandate's penalty is often criticized as not strong enough, removing it would still affect the individual market.\u003c/p>\n\u003cp>\"Insurers would react conservatively and increase rates substantially to cover their risk,\" said insurance industry consultant \u003ca href=\"http://www.healthpol.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Robert Laszewski\u003c/a>.\u003c/p>\n\u003cp>That's what happened after Washington state lawmakers rolled back rules in 1995 legislation. Insurers requested significant rate increases, which were then rejected by the state's insurance commissioner. By 1998, the state's largest insurer — Premera Blue Cross — said it was losing so much money that it would stop selling new individual policies, \"precipitating a sense of crisis,\" according to a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/10804476\" target=\"_blank\" rel=\"noopener noreferrer\">published\u003c/a> in 2000 in the \u003cem>Journal of Health Politics, Policy and Law\u003c/em>.\u003c/p>\n\u003cp>\"When one pulled out, the others followed,\" said current Washington Insurance Commissioner \u003ca href=\"https://www.insurance.wa.gov/about-mike-kreidler\" target=\"_blank\" rel=\"noopener noreferrer\">Mike Kreidler\u003c/a>, who was then a regional director in the federal department of Health and Human Services.\u003c/p>\n\u003cp>The state's individual market was volatile and difficult for years after. Insurers did come back, but won a concession: For a time, the insurance commissioner lost the power to reject rate increases. Kreidler, first elected in 2000, reclaimed that authority.\u003c/p>\n\u003cp>Predicting the effect of removing the individual mandate is difficult, although Kreidler said he expects the impact would be modest, at least initially. Subsidies that help people purchase insurance coverage — if they remain as they are under current law — could help blunt the impact. But if those subsidies are reduced — or other changes are made that further drive healthy people out of the market — the impact could be greater.\u003c/p>\n\u003cp>\"Few markets can go bad on you as fast as a health insurance market,\" said Kreidler.\u003c/p>\n\u003cp>As for employers, dropping the requirement that those with 50 or more workers must offer health insurance or face a financial penalty could mean some workers would lose coverage. But their jobs might be more secure, said \u003ca href=\"http://www.aei.org/scholar/joseph-antos/\" target=\"_blank\" rel=\"noopener noreferrer\">Joseph Antos\u003c/a>, a health care economist and resident scholar at the American Enterprise Institute.\u003c/p>\n\u003cp>That's because the requirement under the ACA meant that some smaller firms didn't hire people or give workers more than 30 hours a week — the minimum needed under the ACA to be considered a full-time worker who qualified for health insurance.\u003c/p>\n\u003cp>The individual mandate, he added, may not be as much of a factor in getting people to enroll in coverage as some think, because the Trump administration has indicated it might not enforce it anyway — and the penalty amount is far less than most people would have to pay for health insurance.\u003c/p>\n\u003cp>However, the individual market could be roiled by other factors, Antos said.\u003c/p>\n\u003cp>\"The real impact would come if feds stopped promoting enrollment and did other things to make the exchanges the state and federal markets through which insurance is offered] work more poorly.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit health newsroom, an editorially independent part of the Kaiser Family Foundation. You can follow KHN senior correspondent Julie Appleby on Twitter \u003c/em>\u003ca href=\"http://twitter.com/Julie_Appleby\">\u003cem>\u003cstrong>@Julie_Appleby\u003c/strong>\u003c/em>\u003c/a>\u003cem> Congressional reporter \u003c/em>\u003ca href=\"https://twitter.com/RachelHBluth\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Rachel Bluth\u003c/em>\u003c/a>\u003cem> also contributed to this report. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=States+Have+Already+Tried+Versions+Of+%27Skinny+Repeal.%27+It+Didn%27t+Go+Well&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>WASHINGTON — After seven years of emphatic campaign promises, Senate Republicans demonstrated Wednesday they don’t have the stomach to repeal Obamacare when it really counts, as the Senate voted 55-45 to reject legislation undoing major portions of Barack Obama’s law without replacing it.\u003c/p>\n\u003cp>Seven Republicans joined all Democrats in rejecting an amendment by Rand Paul of Kentucky that would have repealed most of former President Obama’s health care law, with a two-year delay but no replacement. Congress passed nearly identical legislation in 2015 and sent it to Obama, who unsurprisingly vetoed it.\u003c/p>\n\u003cp>Yet this time, with a president in the White House who says he’s itching to sign the bill, the measure failed on the Senate floor.\u003c/p>\n\u003cp>The Congressional Budget Office has estimated that repealing Obamacare without replacing it would cost more than 30 million Americans their insurance coverage, and that was a key factor in driving away a handful of Republican senators, more than Majority Leader Mitch McConnell could lose in the closely divided Senate.\u003c/p>\n\u003cp>[contextly_sidebar id=”q4yDkDTS4BBB2H9GInIvL8b05XGzSxEH”]\u003c/p>\n\u003cp>The result frustrated other GOP senators, some of whom expressed disbelief that their colleagues would flip-flop on legislation they had voted for only two years ago and long promised to voters. Of the current Republican senators, only moderate Susan Collins of Maine opposed the 2015 repeal bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I think everybody in there, maybe except for one senator, promised their supporters, their voters that they supported repeal of Obamacare,” said Ron Johnson of Wisconsin. “A lot of them said ‘root and branch.’ Now, we’re so far away from that. I’d just remind my colleagues, remember what you promised your voters.”\u003c/p>\n\u003cp>Yet the outcome was no shock in a Senate that’s already shown that unity is elusive when it comes to dealing with Obamacare. The real-world implications of repeal have proved sobering to GOP senators answering to voters who have come to rely on expanded insurance coverage under the law.\u003c/p>\n\u003cp>What the party’s senators will end up agreeing on instead is far from clear. Yet they plunged forward with debate toward their unknown goal, pressured by an impatient president. By week’s end Republicans hope to reach agreement among themselves, and eventually with the House, on some kind of repeal and replacement of the Obama law they have reviled for so long.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>One possibility taking shape in talks among senators was a “skinny repeal” that would abolish just a few of the key elements of Obama’s law, including mandates that everyone purchase insurance and taxes that all GOP senators can agree to oppose.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>WASHINGTON — After seven years of emphatic campaign promises, Senate Republicans demonstrated Wednesday they don’t have the stomach to repeal Obamacare when it really counts, as the Senate voted 55-45 to reject legislation undoing major portions of Barack Obama’s law without replacing it.\u003c/p>\n\u003cp>Seven Republicans joined all Democrats in rejecting an amendment by Rand Paul of Kentucky that would have repealed most of former President Obama’s health care law, with a two-year delay but no replacement. Congress passed nearly identical legislation in 2015 and sent it to Obama, who unsurprisingly vetoed it.\u003c/p>\n\u003cp>Yet this time, with a president in the White House who says he’s itching to sign the bill, the measure failed on the Senate floor.\u003c/p>\n\u003cp>The Congressional Budget Office has estimated that repealing Obamacare without replacing it would cost more than 30 million Americans their insurance coverage, and that was a key factor in driving away a handful of Republican senators, more than Majority Leader Mitch McConnell could lose in the closely divided Senate.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The result frustrated other GOP senators, some of whom expressed disbelief that their colleagues would flip-flop on legislation they had voted for only two years ago and long promised to voters. Of the current Republican senators, only moderate Susan Collins of Maine opposed the 2015 repeal bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I think everybody in there, maybe except for one senator, promised their supporters, their voters that they supported repeal of Obamacare,” said Ron Johnson of Wisconsin. “A lot of them said ‘root and branch.’ Now, we’re so far away from that. I’d just remind my colleagues, remember what you promised your voters.”\u003c/p>\n\u003cp>Yet the outcome was no shock in a Senate that’s already shown that unity is elusive when it comes to dealing with Obamacare. The real-world implications of repeal have proved sobering to GOP senators answering to voters who have come to rely on expanded insurance coverage under the law.\u003c/p>\n\u003cp>What the party’s senators will end up agreeing on instead is far from clear. Yet they plunged forward with debate toward their unknown goal, pressured by an impatient president. By week’s end Republicans hope to reach agreement among themselves, and eventually with the House, on some kind of repeal and replacement of the Obama law they have reviled for so long.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>One possibility taking shape in talks among senators was a “skinny repeal” that would abolish just a few of the key elements of Obama’s law, including mandates that everyone purchase insurance and taxes that all GOP senators can agree to oppose.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Uncertainty Over Obamacare Leaves Next Year's Rates in Limbo",
"title": "Uncertainty Over Obamacare Leaves Next Year's Rates in Limbo",
"headTitle": "The California Report | KQED News",
"content": "\u003cp>California's Obamacare exchange scrubbed its annual rate announcement this week, the latest sign of how the ongoing political drama over the Affordable Care Act is roiling insurance markets nationwide.\u003c/p>\n\u003cp>The exchange, Covered California, might not wrap up negotiations with insurers and announce 2018 premiums for its 1.4 million customers until mid-August — about a month later than usual. Similar scenarios are playing out across the country as state officials and insurers demand clarity on health care rules and funding, with deadlines fast approaching for the start of open enrollment this fall.\u003c/p>\n\u003cp>\"It's insane,\" says John Baackes, CEO of L.A. Care Health Plan, which has about 26,000 customers on the California exchange. \"Here we are in the middle of July, and we don't even know what rules we will be operating under for open enrollment. It is not how you want to run a business.\"\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/538099050/538148888\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Individuals could face sharply higher premiums and fewer choices if more health insurers leave the insurance marketplaces because of lingering uncertainty. State and industry officials around the United States are concerned that the federal government could stop funding so-called \u003ca href=\"https://www.healthcare.gov/glossary/cost-sharing-reduction/\">cost-sharing subsidies\u003c/a> that reduce out-of-pocket costs for people with lower incomes. And they worry the Trump administration won't enforce the individual mandate that requires people to purchase health coverage or pay a penalty.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Amid those concerns, there was a sense of relief Tuesday among many exchange officials and insurers after the U.S. Senate's latest attempt to replace the Affordable Care Act failed.\u003c/p>\n\u003cp>[contextly_sidebar id=\"bm3c8oHiENgCA4FqaK8OlPTCy2vF0O26\"]\u003c/p>\n\u003cp>Two large insurer trade groups bluntly warned last week that parts of the Senate plan were \"unworkable\" and could plunge the market into chaos. In a letter to the Senate, America's Health Insurance Plans and the Blue Cross Blue Shield Association \u003ca href=\"https://www.ahip.org/wp-content/uploads/2017/07/Joint-AHIP-BCBSA-Consumer-Freedom-Option-Letter-FINAL-071417.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">particularly objected\u003c/a> to an amendment by Sen. Ted Cruz, R-Texas, that would have allowed insurers to sell bare-bones health plans to people who wanted cheaper premiums. That provision, the insurers said, would split the market between the healthy and the sick, driving up costs for people with pre-existing conditions.\u003c/p>\n\u003cp>However, the Republicans' failure to pass that replacement plan did not resolve questions swirling around the current health law.\u003c/p>\n\u003cp>Tuesday, \u003ca href=\"http://www.cnbc.com/2017/07/18/trump-well-just-let-obamacare-fail.html\" target=\"_blank\" rel=\"noopener noreferrer\">President Trump expressed disappointment\u003c/a> in the outcome in the Senate, telling reporters, \"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?' \"\u003c/p>\n\u003cp>Some Senate Republicans struck a more conciliatory tone, suggesting that lawmakers should work on a bipartisan measure that would help stabilize the individual insurance markets.\u003c/p>\n\u003cp>Sen. Lamar Alexander, R-Tenn., chairman of the Senate Committee on Health, Education, Labor and Pensions, says he plans to hold hearings in the coming weeks on ways to shore up the individual insurance market. Lawmakers may look at creating a new stabilization fund that helps compensate insurers for higher-cost patients. Such a fund would be similar to one that existed during the first three years of the Affordable Care Act exchanges.\u003c/p>\n\u003cp>[contextly_sidebar id=\"y1ybGndEWDjWP7eczDbajnRjVTw6llOS\"]\u003c/p>\n\u003cp>Some insurance industry executives welcomed the talk of bipartisanship, but they said action must be taken quickly to resolve key issues affecting consumers.\u003c/p>\n\u003cp>\"We are running out of time, and we need a resolution on what we are charging for 2018,\" says Gary Cohen, vice president of public affairs at Blue Shield of California in San Francisco, the \u003ca href=\"http://californiahealthline.org/news/blue-shield-has-highest-share-of-enrollees-in-covered-california/\">largest Covered California insurer by enrollment\u003c/a>.\u003c/p>\n\u003cp>Cohen, who helped launch the exchanges in 2014 as an official in the Obama administration, noted that the Republican bills in both the House and Senate included money for reinsurance that can help lower premiums industrywide. Those provisions are among the \"immediate steps Congress and the Trump administration need to take in order for markets to provide coverage that is affordable,\" Cohen says.\u003c/p>\n\u003cp>Lawmakers could also appropriate federal funds for the cost-sharing subsidies, which have a price tag of about $7 billion a year. Those payments, made directly to insurers, help reduce deductibles and other out-of-pocket costs for policyholders who earn up to 250 percent of the federal poverty level. This year, that's up to about $29,000 for an individual or around $61,000 for a family of four. More than half of the people enrolled in exchanges nationwide qualify for this financial assistance.\u003c/p>\n\u003cp>Without it, many people would face annual deductibles of $2,000 or more when visiting the doctor or undergoing medical tests. That would make people far less likely to sign up with participating insurers.\u003c/p>\n\u003cp>Conservatives generally oppose the subsidies, calling them a bailout of the insurance industry and arguing that the Obama administration didn't have the authority to pay them. \u003ca href=\"http://www.politico.com/story/2017/07/18/trump-obamacare-markets-subsidies-cut-240684\" target=\"_blank\" rel=\"noopener noreferrer\">Trump has repeatedly threatened\u003c/a> to cut off those cost-sharing subsidies as well.\u003c/p>\n\u003cp>With the future of cost-sharing subsidies up in the air, some states, including California and Pennsylvania, have allowed insurers to submit two sets of proposed premiums. One filing reflects continued federal funding of those subsidies, and a separate one assumes they are eliminated and their cost is included in health plan premiums.\u003c/p>\n\u003cp>In Pennsylvania, premiums next year without the subsidies would increase by an average of 20 percent, compared with 9 percent if they remain intact.\u003c/p>\n\u003cp>Pennsylvania Insurance Commissioner Teresa Miller says the market in her state would be in good shape were it not for the uncertainty over federal policy.\u003c/p>\n\u003cp>\"The only thing right now keeping everyone on edge is what's going to happen in Washington, D.C.,\" Miller says. \"If things calm down in D.C. and if we don't see further changes, then Pennsylvania's market really is stabilizing.\"\u003c/p>\n\u003cp>On Tuesday, Covered California officials said the two different rate filings its health plans submitted will be released Aug. 1. The exchange may announce that same day what the final premiums are, or it could postpone the decision for several more weeks if Congress has begun to pursue fixes to the ACA.\u003c/p>\n\u003cp>[contextly_sidebar id=\"5rsh2AhtmI5avdhhlSQpij2OqvMsdJsd\"]\u003c/p>\n\u003cp>\"This decision is based on the ongoing federal uncertainty around the repeal and replacement attempts of the Affordable Care Act and the dramatic potential impacts such uncertainty has on the rates and on California consumers,\" exchange officials said in a statement.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_Consequences_of_Terminating_CSR.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">recent analysis\u003c/a> commissioned by Covered California estimated that premiums for silver-tier plans would jump by 16.6 percent if the federal government stopped paying cost-sharing subsidies. That would be in addition to normal increases meant to cover rising medical costs. An exchange spokeswoman declined to comment further Tuesday, citing the ongoing developments in Washington.\u003c/p>\n\u003cp>In the Florida exchange market, health insurers have sought an average rate increase of nearly 18 percent. But Florida Blue, the state's largest health insurer, said those rates would go even higher if the cost-sharing reduction payments disappeared.\u003c/p>\n\u003cp>Robert Laszewski, an industry consultant in Virginia and a frequent ACA critic, said the exchange markets aren't imploding, despite what the Trump administration has often said. But their premiums will continue to rise unless more young and healthy people are persuaded to buy coverage, he said.\u003c/p>\n\u003cp>\"I think most insurance companies will at least break even, or even make a profit, in 2018,\" Laszewski says. \"Coverage will be 'stable,' but it will stabilize at a horrific premium rate level.\"\u003c/p>\n\u003chr>\n\u003cp>\u003cem>Eric Whitney of Montana Public Radio, Abe Aboraya of WMFE and Ben Allen of WITF contributed to this story.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced as part of a partnership with\u003c/em> \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>,\u003cem> a nonprofit health newsroom and editorially independent part of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Uncertainty+Over+Obamacare+Leaves+Next+Year%27s+Rates+In+Limbo&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "While Washington ponders the future of the Affordable Care Act, health insurers need to decide right now what to charge people for health insurance in 2018. 'It's insane,' says one CEO.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California's Obamacare exchange scrubbed its annual rate announcement this week, the latest sign of how the ongoing political drama over the Affordable Care Act is roiling insurance markets nationwide.\u003c/p>\n\u003cp>The exchange, Covered California, might not wrap up negotiations with insurers and announce 2018 premiums for its 1.4 million customers until mid-August — about a month later than usual. Similar scenarios are playing out across the country as state officials and insurers demand clarity on health care rules and funding, with deadlines fast approaching for the start of open enrollment this fall.\u003c/p>\n\u003cp>\"It's insane,\" says John Baackes, CEO of L.A. Care Health Plan, which has about 26,000 customers on the California exchange. \"Here we are in the middle of July, and we don't even know what rules we will be operating under for open enrollment. It is not how you want to run a business.\"\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/538099050/538148888\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Individuals could face sharply higher premiums and fewer choices if more health insurers leave the insurance marketplaces because of lingering uncertainty. State and industry officials around the United States are concerned that the federal government could stop funding so-called \u003ca href=\"https://www.healthcare.gov/glossary/cost-sharing-reduction/\">cost-sharing subsidies\u003c/a> that reduce out-of-pocket costs for people with lower incomes. And they worry the Trump administration won't enforce the individual mandate that requires people to purchase health coverage or pay a penalty.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Amid those concerns, there was a sense of relief Tuesday among many exchange officials and insurers after the U.S. Senate's latest attempt to replace the Affordable Care Act failed.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Two large insurer trade groups bluntly warned last week that parts of the Senate plan were \"unworkable\" and could plunge the market into chaos. In a letter to the Senate, America's Health Insurance Plans and the Blue Cross Blue Shield Association \u003ca href=\"https://www.ahip.org/wp-content/uploads/2017/07/Joint-AHIP-BCBSA-Consumer-Freedom-Option-Letter-FINAL-071417.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">particularly objected\u003c/a> to an amendment by Sen. Ted Cruz, R-Texas, that would have allowed insurers to sell bare-bones health plans to people who wanted cheaper premiums. That provision, the insurers said, would split the market between the healthy and the sick, driving up costs for people with pre-existing conditions.\u003c/p>\n\u003cp>However, the Republicans' failure to pass that replacement plan did not resolve questions swirling around the current health law.\u003c/p>\n\u003cp>Tuesday, \u003ca href=\"http://www.cnbc.com/2017/07/18/trump-well-just-let-obamacare-fail.html\" target=\"_blank\" rel=\"noopener noreferrer\">President Trump expressed disappointment\u003c/a> in the outcome in the Senate, telling reporters, \"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?' \"\u003c/p>\n\u003cp>Some Senate Republicans struck a more conciliatory tone, suggesting that lawmakers should work on a bipartisan measure that would help stabilize the individual insurance markets.\u003c/p>\n\u003cp>Sen. Lamar Alexander, R-Tenn., chairman of the Senate Committee on Health, Education, Labor and Pensions, says he plans to hold hearings in the coming weeks on ways to shore up the individual insurance market. Lawmakers may look at creating a new stabilization fund that helps compensate insurers for higher-cost patients. Such a fund would be similar to one that existed during the first three years of the Affordable Care Act exchanges.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Some insurance industry executives welcomed the talk of bipartisanship, but they said action must be taken quickly to resolve key issues affecting consumers.\u003c/p>\n\u003cp>\"We are running out of time, and we need a resolution on what we are charging for 2018,\" says Gary Cohen, vice president of public affairs at Blue Shield of California in San Francisco, the \u003ca href=\"http://californiahealthline.org/news/blue-shield-has-highest-share-of-enrollees-in-covered-california/\">largest Covered California insurer by enrollment\u003c/a>.\u003c/p>\n\u003cp>Cohen, who helped launch the exchanges in 2014 as an official in the Obama administration, noted that the Republican bills in both the House and Senate included money for reinsurance that can help lower premiums industrywide. Those provisions are among the \"immediate steps Congress and the Trump administration need to take in order for markets to provide coverage that is affordable,\" Cohen says.\u003c/p>\n\u003cp>Lawmakers could also appropriate federal funds for the cost-sharing subsidies, which have a price tag of about $7 billion a year. Those payments, made directly to insurers, help reduce deductibles and other out-of-pocket costs for policyholders who earn up to 250 percent of the federal poverty level. This year, that's up to about $29,000 for an individual or around $61,000 for a family of four. More than half of the people enrolled in exchanges nationwide qualify for this financial assistance.\u003c/p>\n\u003cp>Without it, many people would face annual deductibles of $2,000 or more when visiting the doctor or undergoing medical tests. That would make people far less likely to sign up with participating insurers.\u003c/p>\n\u003cp>Conservatives generally oppose the subsidies, calling them a bailout of the insurance industry and arguing that the Obama administration didn't have the authority to pay them. \u003ca href=\"http://www.politico.com/story/2017/07/18/trump-obamacare-markets-subsidies-cut-240684\" target=\"_blank\" rel=\"noopener noreferrer\">Trump has repeatedly threatened\u003c/a> to cut off those cost-sharing subsidies as well.\u003c/p>\n\u003cp>With the future of cost-sharing subsidies up in the air, some states, including California and Pennsylvania, have allowed insurers to submit two sets of proposed premiums. One filing reflects continued federal funding of those subsidies, and a separate one assumes they are eliminated and their cost is included in health plan premiums.\u003c/p>\n\u003cp>In Pennsylvania, premiums next year without the subsidies would increase by an average of 20 percent, compared with 9 percent if they remain intact.\u003c/p>\n\u003cp>Pennsylvania Insurance Commissioner Teresa Miller says the market in her state would be in good shape were it not for the uncertainty over federal policy.\u003c/p>\n\u003cp>\"The only thing right now keeping everyone on edge is what's going to happen in Washington, D.C.,\" Miller says. \"If things calm down in D.C. and if we don't see further changes, then Pennsylvania's market really is stabilizing.\"\u003c/p>\n\u003cp>On Tuesday, Covered California officials said the two different rate filings its health plans submitted will be released Aug. 1. The exchange may announce that same day what the final premiums are, or it could postpone the decision for several more weeks if Congress has begun to pursue fixes to the ACA.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"This decision is based on the ongoing federal uncertainty around the repeal and replacement attempts of the Affordable Care Act and the dramatic potential impacts such uncertainty has on the rates and on California consumers,\" exchange officials said in a statement.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_Consequences_of_Terminating_CSR.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">recent analysis\u003c/a> commissioned by Covered California estimated that premiums for silver-tier plans would jump by 16.6 percent if the federal government stopped paying cost-sharing subsidies. That would be in addition to normal increases meant to cover rising medical costs. An exchange spokeswoman declined to comment further Tuesday, citing the ongoing developments in Washington.\u003c/p>\n\u003cp>In the Florida exchange market, health insurers have sought an average rate increase of nearly 18 percent. But Florida Blue, the state's largest health insurer, said those rates would go even higher if the cost-sharing reduction payments disappeared.\u003c/p>\n\u003cp>Robert Laszewski, an industry consultant in Virginia and a frequent ACA critic, said the exchange markets aren't imploding, despite what the Trump administration has often said. But their premiums will continue to rise unless more young and healthy people are persuaded to buy coverage, he said.\u003c/p>\n\u003cp>\"I think most insurance companies will at least break even, or even make a profit, in 2018,\" Laszewski says. \"Coverage will be 'stable,' but it will stabilize at a horrific premium rate level.\"\u003c/p>\n\u003chr>\n\u003cp>\u003cem>Eric Whitney of Montana Public Radio, Abe Aboraya of WMFE and Ben Allen of WITF contributed to this story.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced as part of a partnership with\u003c/em> \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>,\u003cem> a nonprofit health newsroom and editorially independent part of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Uncertainty+Over+Obamacare+Leaves+Next+Year%27s+Rates+In+Limbo&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown",
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"content": "\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">“Nobody knew health care could be so complicated.”\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as “mean”\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be “beautiful,”\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn’t the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That’s why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer’s hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of “single-payer” is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden’s salty choice of words is more politely repeated by the initials “BFD.”\u003c/a> But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">“Nobody knew health care could be so complicated.”\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as “mean”\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be “beautiful,”\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn’t the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That’s why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer’s hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of “single-payer” is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden’s salty choice of words is more politely repeated by the initials “BFD.”\u003c/a> But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>It may be the \u003ca href=\"https://ww2.kqed.org/news/2017/07/18/republican-health-care-bill-falls-short-dealing-blow-to-trump-agenda/\">end of the line\u003c/a> for Congressional Republicans' drive to repeal and replace the Affordable Care Act, as President Trump vows \"\u003ca href=\"https://twitter.com/realDonaldTrump/status/887279050263285761\">we will return!\u003c/a>\" \u003c/p>\n\u003cp>After years of promising to repeal Obamacare and replace it with an alternative health care law, multiple attempts to pass a bill in the Republican-majority Senate have failed.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>Updated 3 p.m. ET\u003c/strong>\u003c/p>\n\u003cp>Senate Republicans on Thursday released a revised version of the Better Care Reconciliation Act, their plan to replace the Affordable Care Act.\u003c/p>\n\u003cp>The new version comes after the Congressional Budget Office found that the original BCRA would in the next decade increase the uninsured population by 22 million over what it would otherwise be. Senate Majority Leader Mitch McConnell had hoped for a vote before July 4, but was \u003ca href=\"http://www.npr.org/2017/06/27/534557208/senate-gop-leaders-push-off-health-care-vote-after-july-4th\">forced to delay\u003c/a> that because he couldn’t garner the 50 votes he needed among the 52 GOP senators.\u003c/p>\n\u003cp>The question now is whether this version of the bill could pass the Senate. Shortly after its release, Maine Sen. Susan Collins and Kentucky Sen. Rand Paul both said they intend to vote against letting the bill go forward. With two no votes, Vice President Pence could provide the 51st vote needed for passage. But if three Republican senators defect, the bill cannot pass.\u003c/p>\n\u003cp>The new bill makes some big changes from the last BCRA draft, but it also leaves some major parts of the original Senate proposal intact — it would still repeal the individual and employer mandates, it would still mean cuts to Medicaid spending, and it would still allow states to opt out of key parts of Obamacare.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In their \u003ca href=\"https://apps.npr.org/documents/document.html?id=3894093-Summary-Revised-Senate-Health-Care-Bill-7-13-17\">summary of the bill\u003c/a>, Senate Republicans laid out the major provisions. Here are some of those big changes that this new version of the bill would make to the original BCRA, and what they would mean:\u003c/p>\n\u003cp>\u003cstrong>Health savings accounts will be able to pay for premiums. \u003c/strong>Under IRS rules, people with high-deductible plans are eligible for health savings accounts (HSAs), accounts into which people can put money for health care expenses tax-free. Under this bill, people would for the first time be able to use that money for premiums. Americans’ deposits in HSAs have ballooned over the last decade, according to \u003ca href=\"http://www.devenir.com/health-savings-account-assets-up-22-percent-in-2016/\">HSA consulting firm Devenir\u003c/a>. However, those accounts also tend to benefit higher-income people more than others, as Kaiser Health News’ Michelle Andrews wrote in December — for example, richer people are more likely to have the extra money to sock away for health expenses.\u003c/p>\n\u003cp>\u003cstrong>More money for the opioid epidemic. \u003c/strong>The Senate’s initial bill offered $2 billion to address the opioid crisis for 2018. This version would offer about $45 billion over 10 years, which is what Ohio Sen. Rob Portman and West Virginia Sen. Shelley Moore Capito, both Republicans, \u003ca href=\"http://www.pbs.org/newshour/rundown/two-gop-senators-wanted-45-billion-health-care-bill-battle-opioid-crisis-got-2-billion/\">had requested\u003c/a> at one point. However, some experts say that around $4.5 billion a year is nowhere near enough for combating America’s massive opioid epidemic, as the \u003ca href=\"https://www.nytimes.com/2017/06/30/health/drug-treatment-opioid-abuse-heroin-medicaid.html\">New York Times reported in June\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Keeping some Obamacare taxes. \u003c/strong>The first BCRA version would have repealed an array of Affordable Care Act taxes, which would have overwhelmingly benefited higher-income Americans. This newer version of the bill keeps some in place, including the \u003ca href=\"http://www.taxpolicycenter.org/briefing-book/what-tax-changes-did-affordable-care-act-make\">net investment income tax and a payroll tax\u003c/a> that hit higher-income Americans.\u003c/p>\n\u003cp>\u003cstrong>Allowing insurers to offer non-Obamacare-qualified plans. \u003c/strong>This mirrors an idea that Texas Sen. Ted Cruz and Utah Sen. Mike Lee had proposed in recent weeks: The Senate’s bill would allow an insurer to offer skimpier plans. As long as an insurer does offer a plan on the individual insurance exchanges that meets the \u003ca href=\"https://www.dpc.senate.gov/healthreformbill/healthbill04.pdf\">demands of Obamacare’s Title I\u003c/a> (for example, covering certain areas like preventive care and protecting people with pre-existing conditions), that insurer will be allowed to offer additional plans off of the individual insurance exchanges that \u003cem>don’t\u003c/em> meet those criteria.\u003c/p>\n\u003cp>That idea had created worries of a two-tiered insurance system — one in which older and sicker people would opt into the more comprehensive plans, while younger and healthier people would choose the cheaper plans that covered less, potentially causing a “death spiral” on the exchanges for those older and sicker people.\u003c/p>\n\u003cp>\u003cstrong>Extra money for high-risk customers. \u003c/strong>If an insurer offers one of those plans that meet the Obamacare criteria, that insurer would be eligible for money from a fund designed to help high-risk customers, which could potentially mitigate some of the two-tier issues created by new, nonqualified plans.\u003c/p>\n\u003cp>\u003cstrong>Extra stabilization money.\u003c/strong> The original version of the BCRA provided $112 billion that would have allowed states to stabilize their markets or help high-risk customers in a wide variety of ways. In this version, that is bumped up to $182 billion.\u003c/p>\n\u003chr>\n\u003cp>This all means that the new version doesn’t make major changes to one big part of the BCRA: Medicaid. Under the original Senate bill, the Obamacare Medicaid expansion would be rolled back, and Medicaid spending would be capped — states would either be allotted a certain amount per capita, or they could get a block grant instead. It also caps Medicaid spending growth in the medium-to-long-term. This bill doesn’t change any of that.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">According to the CBO\u003c/a>, the original BCRA would have cut Medicaid spending by $772 billion over 10 years, and would have resulted in 15 million fewer Medicaid enrollees by 2026 than under current law.\u003c/p>\n\u003cp>A new CBO score on the bill is expected Monday or Tuesday. By the end of next week, there is likely to be a key procedural vote. That would put things on track for a final vote the following week.\u003c/p>\n\u003cp>Were this bill to pass the Senate, it would then have to be reconciled with the House’s attempt to repeal and replace Obamacare, known as the American Health Care Act.\u003c/p>\n\u003cp>Meanwhile, Republicans Bill Cassidy of Louisiana and Lindsey Graham of South Carolina released an alternative plan Thursday morning.\u003c/p>\n\u003cp>A summary of the bill is embedded below. You can read \u003ca href=\"https://apps.npr.org/documents/document.html?id=3894050-Revised-Senate-Health-Care-Bill-7-13-17\">the full draft here\u003c/a>, and see \u003ca href=\"https://apps.npr.org/documents/document.html?id=3877539-Senate-GOP-Health-Care-Bill-Discussion-Draft\">the previous Senate version here\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Washington Desk editor Arnie Seipel contributed to this report\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Senate+Health+Care+Bill+Revisions+Released+In+Attempt+To+Appease+GOP+Critics&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Updated 3 p.m. ET\u003c/strong>\u003c/p>\n\u003cp>Senate Republicans on Thursday released a revised version of the Better Care Reconciliation Act, their plan to replace the Affordable Care Act.\u003c/p>\n\u003cp>The new version comes after the Congressional Budget Office found that the original BCRA would in the next decade increase the uninsured population by 22 million over what it would otherwise be. Senate Majority Leader Mitch McConnell had hoped for a vote before July 4, but was \u003ca href=\"http://www.npr.org/2017/06/27/534557208/senate-gop-leaders-push-off-health-care-vote-after-july-4th\">forced to delay\u003c/a> that because he couldn’t garner the 50 votes he needed among the 52 GOP senators.\u003c/p>\n\u003cp>The question now is whether this version of the bill could pass the Senate. Shortly after its release, Maine Sen. Susan Collins and Kentucky Sen. Rand Paul both said they intend to vote against letting the bill go forward. With two no votes, Vice President Pence could provide the 51st vote needed for passage. But if three Republican senators defect, the bill cannot pass.\u003c/p>\n\u003cp>The new bill makes some big changes from the last BCRA draft, but it also leaves some major parts of the original Senate proposal intact — it would still repeal the individual and employer mandates, it would still mean cuts to Medicaid spending, and it would still allow states to opt out of key parts of Obamacare.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In their \u003ca href=\"https://apps.npr.org/documents/document.html?id=3894093-Summary-Revised-Senate-Health-Care-Bill-7-13-17\">summary of the bill\u003c/a>, Senate Republicans laid out the major provisions. Here are some of those big changes that this new version of the bill would make to the original BCRA, and what they would mean:\u003c/p>\n\u003cp>\u003cstrong>Health savings accounts will be able to pay for premiums. \u003c/strong>Under IRS rules, people with high-deductible plans are eligible for health savings accounts (HSAs), accounts into which people can put money for health care expenses tax-free. Under this bill, people would for the first time be able to use that money for premiums. Americans’ deposits in HSAs have ballooned over the last decade, according to \u003ca href=\"http://www.devenir.com/health-savings-account-assets-up-22-percent-in-2016/\">HSA consulting firm Devenir\u003c/a>. However, those accounts also tend to benefit higher-income people more than others, as Kaiser Health News’ Michelle Andrews wrote in December — for example, richer people are more likely to have the extra money to sock away for health expenses.\u003c/p>\n\u003cp>\u003cstrong>More money for the opioid epidemic. \u003c/strong>The Senate’s initial bill offered $2 billion to address the opioid crisis for 2018. This version would offer about $45 billion over 10 years, which is what Ohio Sen. Rob Portman and West Virginia Sen. Shelley Moore Capito, both Republicans, \u003ca href=\"http://www.pbs.org/newshour/rundown/two-gop-senators-wanted-45-billion-health-care-bill-battle-opioid-crisis-got-2-billion/\">had requested\u003c/a> at one point. However, some experts say that around $4.5 billion a year is nowhere near enough for combating America’s massive opioid epidemic, as the \u003ca href=\"https://www.nytimes.com/2017/06/30/health/drug-treatment-opioid-abuse-heroin-medicaid.html\">New York Times reported in June\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Keeping some Obamacare taxes. \u003c/strong>The first BCRA version would have repealed an array of Affordable Care Act taxes, which would have overwhelmingly benefited higher-income Americans. This newer version of the bill keeps some in place, including the \u003ca href=\"http://www.taxpolicycenter.org/briefing-book/what-tax-changes-did-affordable-care-act-make\">net investment income tax and a payroll tax\u003c/a> that hit higher-income Americans.\u003c/p>\n\u003cp>\u003cstrong>Allowing insurers to offer non-Obamacare-qualified plans. \u003c/strong>This mirrors an idea that Texas Sen. Ted Cruz and Utah Sen. Mike Lee had proposed in recent weeks: The Senate’s bill would allow an insurer to offer skimpier plans. As long as an insurer does offer a plan on the individual insurance exchanges that meets the \u003ca href=\"https://www.dpc.senate.gov/healthreformbill/healthbill04.pdf\">demands of Obamacare’s Title I\u003c/a> (for example, covering certain areas like preventive care and protecting people with pre-existing conditions), that insurer will be allowed to offer additional plans off of the individual insurance exchanges that \u003cem>don’t\u003c/em> meet those criteria.\u003c/p>\n\u003cp>That idea had created worries of a two-tiered insurance system — one in which older and sicker people would opt into the more comprehensive plans, while younger and healthier people would choose the cheaper plans that covered less, potentially causing a “death spiral” on the exchanges for those older and sicker people.\u003c/p>\n\u003cp>\u003cstrong>Extra money for high-risk customers. \u003c/strong>If an insurer offers one of those plans that meet the Obamacare criteria, that insurer would be eligible for money from a fund designed to help high-risk customers, which could potentially mitigate some of the two-tier issues created by new, nonqualified plans.\u003c/p>\n\u003cp>\u003cstrong>Extra stabilization money.\u003c/strong> The original version of the BCRA provided $112 billion that would have allowed states to stabilize their markets or help high-risk customers in a wide variety of ways. In this version, that is bumped up to $182 billion.\u003c/p>\n\u003chr>\n\u003cp>This all means that the new version doesn’t make major changes to one big part of the BCRA: Medicaid. Under the original Senate bill, the Obamacare Medicaid expansion would be rolled back, and Medicaid spending would be capped — states would either be allotted a certain amount per capita, or they could get a block grant instead. It also caps Medicaid spending growth in the medium-to-long-term. This bill doesn’t change any of that.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">According to the CBO\u003c/a>, the original BCRA would have cut Medicaid spending by $772 billion over 10 years, and would have resulted in 15 million fewer Medicaid enrollees by 2026 than under current law.\u003c/p>\n\u003cp>A new CBO score on the bill is expected Monday or Tuesday. By the end of next week, there is likely to be a key procedural vote. That would put things on track for a final vote the following week.\u003c/p>\n\u003cp>Were this bill to pass the Senate, it would then have to be reconciled with the House’s attempt to repeal and replace Obamacare, known as the American Health Care Act.\u003c/p>\n\u003cp>Meanwhile, Republicans Bill Cassidy of Louisiana and Lindsey Graham of South Carolina released an alternative plan Thursday morning.\u003c/p>\n\u003cp>A summary of the bill is embedded below. You can read \u003ca href=\"https://apps.npr.org/documents/document.html?id=3894050-Revised-Senate-Health-Care-Bill-7-13-17\">the full draft here\u003c/a>, and see \u003ca href=\"https://apps.npr.org/documents/document.html?id=3877539-Senate-GOP-Health-Care-Bill-Discussion-Draft\">the previous Senate version here\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Washington Desk editor Arnie Seipel contributed to this report\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Senate+Health+Care+Bill+Revisions+Released+In+Attempt+To+Appease+GOP+Critics&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"tagline": "The flip side of gentrification, told through one town",
"info": "Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?",
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"order": 19
},
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328",
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"rss": "https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"
}
},
"baycurious": {
"id": "baycurious",
"title": "Bay Curious",
"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg",
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"order": 3
},
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}
},
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"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
"airtime": "MON-FRI 9pm-10pm, TUE-FRI 1am-2am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
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"source": "BBC World Service"
},
"link": "/radio/program/bbc-world-service",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
"title": "Close All Tabs",
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"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
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"order": 1
},
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"code-switch-life-kit": {
"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg",
"meta": {
"site": "radio",
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},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
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},
"commonwealth-club": {
"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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}
},
"forum": {
"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"meta": {
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"source": "kqed",
"order": 9
},
"link": "/forum",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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},
"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
}
},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"title": "Here & Now",
"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/hiddenbrain.jpg",
"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"how-i-built-this": {
"id": "how-i-built-this",
"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
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"link": "/radio/program/how-i-built-this",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"order": 15
},
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"order": 18
},
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
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