March 26, 2019

Two Cabinet secretaries — Attorney General William Barr and Health and Human Services Secretary Alex Azar — pushed back on the Trump administration's recent decision to reverse course and try to invalidate the Affordable Care Act, three people with knowledge of the matter told Politico.

In a letter sent to the U.S. 5th Circuit Court of Appeals on Monday, the Justice Department said federal lawyers will file a brief in support of a December district court ruling that the ACA's individual mandate is unconstitutional, and this renders the entire law invalid. Talks have been underway since late last year, with Azar arguing in December that there was no reason to fully repeal ObamaCare because Republicans don't have an alternative plan.

Barr was confirmed earlier this year, and "his opposition was based in part on skepticism among conservative lawyers about the wisdom of seeking to overturn the law," Politico reports. He was overruled by the White House on this ACA reversal plan, and he must now lead the Justice Department as it works to topple the health-care law.

Acting White House Chief of Staff Mick Mulvaney was once a congressman from South Carolina, a Tea Party ultra-conservative and one of the loudest critics of the ACA. Two of his close allies — acting director of the Office of Management and Budget Russ Vought and domestic policy chief Joe Grogan — pushed for the DOJ to back the December ruling, people with knowledge of the matter told Politico. Catherine Garcia

December 22, 2017

The Centers for Medicare and Medicaid Services released the 2018 enrollment numbers for Affordable Care Act health plans on Thursday, and the number — 8.8 million people signing up for plans — surprised ObamaCare critics and proponents alike. The final number, 96 percent of 2017's 9.2. enrollments, came after a big rush in the final week, when 4.1 million people signed up for plans. Some 2.4 million people who signed up were new customers, and 1 million of them enrolled in the final week, setting a new one-week record. Among the 6.4 million returning customers, CMS said some undisclosed number were automatically re-enrolled.

Some of the 8.8 million may not pay their premiums and therefore won't get health insurance, and the 11 states that run their own insurance markets aren't included in the total. But the robust enrollment numbers came after a year in which President Trump and congressional Republicans repeatedly tried to dismantle the law, and a significantly truncated enrollment period where 90 percent of the advertising and outreach budget had been cut, as well as two-fifths of the funds for insurance "navigators" who help people sign up. Polls and on-the-ground reporting also showed that people were confused about whether ObamaCare still existed.

CMS Administrator Seema Verma — who had lobbied Congress to repeal ObamaCare over the summer — focused on the website's stability and cost savings, noting that the Trump administration spent only $1 on outreach per each enrollee versus $11 last year under former President Barack Obama. She announced the final numbers in a Thursday afternoon tweet, 24 hours later than the usual release day.

Trump has taken other steps to erode ObamaCare markets, and the GOP tax plan Congress just passed axes the mandate that individuals have insurance, which Senate Majority Leader Mitch McConnell (R-Ky.) said Thursday "takes the heart out of ObamaCare." But McConnell also shot down a push from his caucus to try to repeal the law again next year, saying with a 51-49 Senate, "we'll probably move on to other issues." Peter Weber

October 6, 2017

The Trump administration has been sharply curtailing outreach to promote health-care sign-ups under Affordable Care Act exchanges — cutting the enrollment period in half, scheduling outages for HealthCare.gov on Sundays and other popular times, slashing the advertising budget, and axing grants for groups that help people enroll — but President Trump and his aides are also quietly denying waivers for states trying to increase competition and lower costs for residents. And in at least one case, The Washington Post reports, Trump himself said no.

Officials in GOP-controlled Iowa had requested a Section 1332 waiver to transform the state's ObamaCare exchanges along conservative lines to expand marketplace options and contain premiums, and after Trump read about Iowa's plan, closely watched by other states, in The Wall Street Journal, he grew angry, The Washington Post reports, citing an individual briefed on what happened:

Trump first tried to reach [then-HHS Secretary Tom] Price, the individual recounted, but the secretary was traveling in Asia and unavailable. The president then called Seema Verma, administrator of the Centers for Medicare and Medicaid Services, the agency charged with authorizing or rejecting Section 1332 applications. CMS had been working closely with Iowa as it fine-tuned its submission. ... Trump's message in late August was clear: ... Tell Iowa no. [The Washington Post]

The Trump administration has also effectively nixed a request from Oklahoma, which detailed its frustration in a letter last Friday, and other red and blue states. ObamaCare supporters see these rejected waivers as part of a broader ObamaCare sabotage effort. Sen. Patty Murray (D-Wash.), who is working on a bipartisan Senate plan to fix ObamaCare issues, warned that if Trump "is only interested in sabotaging the market, that is a dangerous road for him to ride, because he will own it." You can read more at The Washington Post. Peter Weber

August 11, 2017

President Trump has been hammering Senate Majority Leader Mitch McConnell over the failure by Senate Republicans to pass an ObamaCare repeal plan, and he's urged the Senate to take back up repeal-and-replace legislation before moving on to other big legislation. Only 34 percent of Americans agree with him, while 62 percent favor moving on, including 47 percent of Republicans, according to a Kaiser Family Foundation poll released Friday. A 60 percent majority said it is a "good thing" the Senate failed to pass an ObamaCare repeal bill, 51 percent say they're "relieved," 47 percent are "happy," 38 percent "disappointed," and 19 percent "angry."

Meanwhile, 57 percent of Americans said they want Republicans to work with Democrats to improve the law. And not only do 78 percent of Americans want the Trump administration to do what it can to make ObamaCare work, but that includes 52 percent of Republicans and 51 percent of Trump supporters.

Overall, 52 percent of respondents now approve of ObamaCare — a 9 point jump since Trump's election — while 39 percent disapprove. Sixty percent of respondents said that Trump and Republicans are responsible for the Affordable Care Act, but only 36 percent of Republicans and Trump supporters agreed with that proposition, with 56 percent and 53 percent, respectively, saying Democrats and former President Barack Obama are responsible.

Trump has suggested he might scrap subsidies that help insurance companies insure seven million low-income people to get Democrats to come to the negotiating table, but 63 percent of respondents disagree with such hardball tactics, though 58 percent of Republicans approve. Strong majorities disapprove of Trump trying weaken the ObamaCare marketplace by cutting off advertising and outreach, though 66 percent of Republicans favor not enforcing the individual mandate (overall, Americans disapprove of that tactic, 65 percent to 31 percent). The uncertainty is already raising premiums, according to a separate KFF study.

The growing support for the law, and opposition to undermining it, among independents might "help explain why some centrist Republicans who rely on moderate voters' support opposed repeal or backed it only after winning some concessions," The Associated Press suggests. The poll was conducted Aug. 1-6, after the Senate repeal failure, among 1,211 adults, and it has a margin of error of ±3 percentage points. Peter Weber

May 11, 2017

Aetna announced Wednesday that it would stop offering ObamaCare health insurance coverage next year in Delaware and Nebraska, the only two states where it is still participating in the Affordable Care Act's individual insurance market. Aetna had already announced it was pulling out of Virginia and Iowa after exiting several other states in 2016. Rival insurers Humana and UnitedHealth Group also have dropped out of most of the government subsidized individual health insurance exchanges. House Republicans voted last week to repeal and replace key elements of ObamaCare, although the measure faces tougher opposition in the Senate. Harold Maass

February 23, 2017

On Thursday, former Republican House Speaker John Boehner claimed that a full repeal and replace of the Affordable Care Act is "not going to happen," calling the suggestion that it might just "happy talk," Politico reports.

Boehner, who resigned in 2015, instead suggested that there would be small changes to ObamaCare. "Most of the framework of the Affordable Care Act … that's going to be there," Boehner predicted. He added that he "started laughing" when he heard of President Trump's plans to quickly push through health-care reform: "Republicans never agree on health care," Boehner said.

President Trump has suggested that he will have a new health care plan by mid-March, but Boehner said he isn't buying it. "[Congressional Republicans are] going to fix ObamaCare — I shouldn't call it repeal-and-replace, because it's not going to happen," he said. Jeva Lange

January 27, 2017

If you're one of those people who needs a last-minute nudge to complete your health insurance paperwork, and your health insurance comes through the Affordable Care Act, you're apparently on your own this year. The Trump White House has ordered the Heath and Human Services Department to scrap all advertising and outreach on ObamaCare in the crucial final five days of the open enrollment period, HHS and Capitol Hill sources tell Politico. That includes reminders to people who have begun enrolling through HeathCare.gov and even ads that have already been paid for, according to the sources.

As of Jan. 4, 8.8 million people have already signed up for coverage on the federal ObamaCare exchanges, a slight increase even as Trump and Republicans in Congress began the process of gutting the law. HHS had projected that 13.8 million people would sign up by the Jan. 31 deadline, and in past years, the final five days have seen a rush of last-minute enrollments, especially from the younger and healthier people the insurance system needs to function properly. Without the ads and reminders, those numbers are expected to fall short.

"President Trump is signaling he's the new sheriff," Rep. Chris Collins, (R-N.Y.), Trump's top congressional ally, tells Politico. "He's been elected with a mandate. He's not going to tolerate his employees contradicting and undermining his mandate to get this country going in another direction."

And it is true, the sunny ads — which feature young, healthy people getting cheap insurance — do contradict Trump's assertion, as to ABC News' David Muir, that ObamaCare is "too expensive. It's horrible health care. It doesn't cover what you have to cover. It's a disaster."

Trump has also been arguing — to House Republicans, for example, and on ABC News — that ObamaCare is exploding under its own weight. (Here's a counterargument.) "I told the Republicans this, the best thing we could do is nothing for two years, let it explode," Trump told Muir on Wednesday. "And then we'll go in and we'll do a new plan and — and the Democrats will vote for it.... If I didn't do anything for two years they'd be begging me to do something." Well, you can't say Trump is doing nothing. Peter Weber

January 6, 2017

Republicans' developing plan to deal with ObamaCare is "repeal and delay": They'll immediately pass legislation undoing the Affordable Care Act, but it will have a built-in grace period of two to four years to allow the GOP to develop and transition to a viable alternative.

In an essay for the New England Journal of Medicine published Friday — President Obama's third contribution to an academic journal while in office and his second this week — the president castigated this course of action as a "reckless" endangerment of Americans' health care which puts politics above people. "Republican congressional leaders say they will repeal the ACA early this year, with a promise to replace it in subsequent legislation," Obama writes, but they "have yet to introduce that 'replacement bill,' hold a hearing on it, or produce a cost analysis — let alone engage in the more than a year of public debate that preceded passage of the ACA."

The climate of short-term uncertainty the delay would create could have a multitude of serious ramifications, Obama argues. "This approach of 'repeal first and replace later' is, simply put, irresponsible — and could slowly bleed the health care system that all of us depend on."

The "repeal and delay" plan also faces opposition from within GOP ranks thanks to Sen. Rand Paul (R-Ky.), who this week indicated that though he supports a repeal he will vote against the current repeal resolution as it assumes $9 trillion in additional federal debt over the next decade. Bonnie Kristian

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