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Letting States Decide Health Coverage Could Make It Harder To Buy

House Ways and Means Committee Chairman Rep. Kevin Brady, R-Texas, says the latest version of the GOP bill would let states decide on required benefits.

J. Scott Applewhite/AP

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J. Scott Applewhite/AP

House Ways and Means Committee Chairman Rep. Kevin Brady, R-Texas, says the latest version of the GOP bill would let states decide on required benefits.

J. Scott Applewhite/AP

A last-minute attempt by conservative Republicans to dump standards for health benefits in plans sold to individuals would probably lower the average person’s upfront insurance costs, such as premiums and deductibles, say analysts on both sides of the debate to repeal and replace the Affordable Care Act.

But it will very likely also induce insurers to offer much skimpier plans, potentially excluding the gravely ill and putting consumers at greater financial risk if they need care.

As part of the push by House GOP leaders to gain more support for their plan, they amended the bill Thursday to allow states to decide, starting next year, which, if any, benefits insurers must provide on the individual market, rather than requiring health plans to include the Affordable Care Act’s 10 “essential health benefits, according to House Ways and Means Chairman Kevin Brady, R-Texas.

For example, a woman who had elected not to have maternity coverage could face financial ruin from an unintended pregnancy. A healthy young man who didn’t buy drug coverage could be bankrupted if diagnosed with cancer requiring expensive prescription medicine. Someone needing emergency treatment at a nonnetwork hospital might not be covered.

What might be desirable for insurers would leave patients vulnerable.

GOP Health Bill Changes Could Kill Protections For Those With Pre-Existing Conditions

“What you don’t want if you’re an insurer is only sick people buying whatever product you have,” says Christopher Koller, president of the Milbank Memorial Fund and a former Rhode Island insurance commissioner. “So the way to get healthy people is to offer cheaper products designed for the healthy people.”

Such a change could give carriers wide room to do that by shrinking or eliminating from plan requirements the 10 essential health benefits required by the ACA, including hospitalization, prescription drugs, mental health treatment and lab services — especially if state regulators don’t step in to fill the void, analysts said.

Conservative House Republicans want to exclude the rule from any replacement, arguing it drives up cost and stifles consumer choice.

On Thursday, President Trump agreed after meeting with members of the conservative Freedom Caucus to leave required essential benefits out of the measure under consideration, according to White House press secretary Sean Spicer. “Part of the reason that premiums have spiked out of control is because under Obamacare, there were these mandated services that had to be included,” Spicer told reporters.

Pushed by Trump, House Republican leaders agreed late Thursday to a Friday vote on the bill, but they were still trying to line up support.

“Tomorrow we will show the American people that we will repeal and replace this broken law because it’s collapsing and it’s failing families,” said House Speaker Paul Ryan, R-Wis. “And tomorrow we’re proceeding.” When asked if he had the votes, Ryan didn’t answer and walked briskly away from the press corps.

Trump Faces Most Consequential Day Of His Presidency So Far

But axing essential benefits could bring back the pre-ACA days when insurers avoided expensive patients by excluding services they needed, says Gary Claxton, a vice president at the Kaiser Family Foundation who analyzes health care markets. (Kaiser Health News is an editorially independent program of the foundation.)

“They’re not going to offer benefits that attract people with chronic illness if they can help it,” said Claxton, whose collection of old insurance policies shows what the market looked like before.

One Aetna plan didn’t cover most mental health or addiction services — important to moderate Republicans as well as Democrats concerned about fighting the opioid crisis. Another Aetna plan didn’t cover any mental health treatment. A HealthNet plan didn’t cover outpatient rehabilitative services.

Before the ACA, most individual plans didn’t include maternity coverage either.

The House replacement bill could make individual coverage for the chronically ill even more scarce than a few years ago because it retains an ACA rule that forces plans to accept members with pre-existing illnesses, analysts say.

Before President Barack Obama’s health care overhaul, insurers could reject sick applicants or charge them higher premiums.

Lacking that ability under the proposed Republican law but newly able to shrink benefits, insurers might be more tempted than ever to avoid covering expensive conditions. That way the sickest consumers wouldn’t even bother to apply.

“You could see even worse holes in the insurance package” than before the ACA, says Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University. “If we’re going into a world where a carrier is going to have to accept all comers and they can’t charge them based on their health status, the benefit design becomes a much bigger deal” in how insurers keep the sick out of their plans, she says.

Michael Cannon, an analyst at the libertarian Cato Institute and longtime Obamacare opponent, also believes that dumping essential benefits while forcing insurers to accept all applicants at one “community” price would weaken coverage for chronically ill people.

“Getting rid of the essential health benefits in a community-rated market would cause coverage for the sick to get even worse than it is under current law,” he says. Republicans “are shooting themselves in the foot if they offer this proposal.”

Cannon favors full repeal of the ACA, allowing insurers to charge higher premiums for more expensive patients and helping consumers pay for plans with tax-favored health savings accounts.

In an absence of federal requirements for benefits, existing state standards would become more important. Some states might move to upgrade required benefits in line with the ACA rules, but others probably won’t, according to analysts.

“You’re going to have a lot of insurers in states trying to understand what existing laws they have in place,” Koller says. “It’s going to be really critical to see how quickly the states react. There are going to be some states that will not.”

Mary Agnes Carey and Phil Galewitz contributed to this story. Kaiser Health News is an editorially independent newsroom that is part of the nonpartisan Henry J. Kaiser Family Foundation.

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How the Health Care Vote Fell Apart, Step by Step

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President Trump sits down with truckers to talk health care, jobs

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Trucking Associations CEO: Obamacare hurt our industry

While Republican leaders were busy most of the day Thursday trying to rally House support behind the GOP-proposed American Health Care Act, President Donald Trump met with some of the trucking industry’s biggest names, and their dialogue focused on health care.

“We’re the ones out there moving the economy,” Chris Spear, chief executive officer of the American Trucking Associations, told CNBC’s “Closing Bell” after the meeting. Spear said the group had an “outstanding conversation” with Trump.

Trucking is a $725 billion industry, employing around 7.3 million Americans and delivering 70 percent of the nation’s goods. One in 16 jobs in the U.S. goes to a trucker, Spear told CNBC, and in 29 states the most popular job is truck driver.

The Affordable Care Act, or Obamacare, has severely hurt the industry of late, Spear said. “Rising insurance costs, administrative burdens, lack of choice … the status quo is not acceptable to our industry, with all the people we employ. For us, it’s a jobs issue.”

President Donald Trump sits in the drivers seat of a semi-truck as he welcomes truckers and CEOs to the White House in Washington, DC, March 23, 2017, to discuss healthcare.

Many prominent leaders of the trucking industry have said they stand behind Trump and his stance on removing current health-care mandates and empowering individuals and businesses to make their own decisions.

“Having a good, strong health-care platform is really important to us,” Spear told CNBC. Further, he wants to see a health-care bill that “makes sense” and one that’s easy to understand.

Spear said the industry has seen many negative impacts from Obamacare, such as one Wisconsin trucking company that currently averages monthly premiums of $2,300 and can no longer invest into its business.

Fleet growth has slowed, and there is a shortage of nearly 50,000 drivers in the sector today, industry data show.

Trump has said he intends to make the country more aware of truck drivers’ challenges, health care being a top priority.

To be sure, a very small minority of U.S. voters, just 17 percent of them, support the Republican plan to repeal and replace key parts of Obamacare, while 56 percent of voters disapprove of the bill, a new poll shows.

Those attending Thursday’s meeting at the White House included Mike Ducker, president and CEO of FedEx Freight’; David Congdon, CEO of Old Dominion Freight Line; and Rich McArdle, president of UPS Freight. A dozen truck drivers were also invited.

— CNBC’s Dan Mangan contributed to this story.

Lauren Thomas


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GOP Resurrects A Bill From 2003 To Help Small Firms Buy Health Insurance

Republicans have long argued that small businesses should be able to band together and buy coverage across state lines. This legislation enables that.

Republicans have long argued that small businesses should be able to band together and buy coverage across state lines. This legislation enables that.

In a bid to improve the health insurance purchasing clout of small businesses, Republicans in the U.S. House of Representatives dusted off a piece of controversial legislation more than a decade old and passed it this week as part of their effort to remake the market after they throw out the Affordable Care Act.

The bill, the Small Business Health Fairness Act of 2017, had the support of 232 Republicans and 4 Democrats. It now heads to the Senate, where its fate is uncertain, experts say.

Health Insurance Woes Add To The Risky Business Of Farming

The earlier bill, which passed the House in 2003 but didn’t advance, was widely panned by groups representing consumers, providers, the health insurance industry and state officials. At the time, they argued that it would do little to enhance the coverage options or control costs of many small businesses, especially those that employ older, sicker workers. Also, the critics said, the proposal would weaken consumer protections against plan insolvency and fraud.

Health policy analysts say there’s no reason to change that assessment now.

“It was a bad idea in 2003 and it’s a worse idea today,” says Timothy Jost, an emeritus professor at Washington and Lee University School of Law in Virginia, and author of widely used text books on health law.

Republicans have long advocated for small businesses to be able to band together and buy coverage across state lines, and this legislation does that.

The bill would allow the establishment of nationwide “association health plans” that could be offered by professional or trade groups, chambers of commerce and the like. Small businesses could buy coverage through these associations, in theory gaining strength in numbers to enhance their bargaining leverage with insurers — leading to cheaper, better coverage and lower administrative costs.

Speaker Paul Ryan (R-Wis.) has expressed enthusiasm for association health plans and wanted to move the legislation in tandem with the reconciliation bill that would unwind budget-related provisions of Obamacare.

Several business groups, including the National Retail Federation and the U.S. Chamber of Commerce, support the bill, hoping that it will encourage more small businesses to offer their employees coverage.

“We don’t think it’s going to be the panacea to solve all our members’ issues, but we view it as a valuable option,” said Kevin Kuhlman, director of government relations for the National Federation of Independent Business, a trade group and supporter of the bill. NFIB members, he said, “want a little more ability to design their own options and less responsibility to conform to federal requirements.”

The idea isn’t new. Association health plans have existed for decades. But they often escaped close supervision because neither states nor the federal government had clear regulatory authority over them. In the 1970s and 80s, there were cases of fraud and insolvency that raised concerns about the model. Some multiple-employer purchasing groups went belly up and left consumers and providers with millions in unpaid claims.

So Congress amended federal law to allow states to regulate these plans. When the ACA passed in 2010, the Obama administration required that association health plans meet the new standards for small group plans: They had to cover the 10 essential health benefits, for example, and couldn’t charge older people monthly insurance premiums that were more than three times higher than those of younger people.

The new bill would change all that. It would eliminate most state regulation of association health plans and put oversight in the hands of the federal Department of Labor, which would certify the plans.

How Many Would Lose Health Coverage? It Depends On How You Define 'Insurance'

The ACA requirements that apply to all plans, like the prohibition on lifetime and annual coverage limits, would apply to association health plans as well, said Kevin Lucia, a research professor at Georgetown University’s Center on Health Insurance Reforms. But the ACA’s small-group requirements would not apply.

Plans from associations could offer stripped down coverage and would have more latitude in setting premiums than regular plans in the small-group market. They could operate in multiple states and generally avoid state-mandated benefits and other state insurance rules.

Under the Republican bill, association health plans still couldn’t discriminate against individuals based on their health, but they could charge higher premiums to companies with sicker workers. So association health plans would likely appeal to employers with younger, healthier workers who would qualify for lower rates and be less troubled by skimpier coverage.

That could draw those businesses away from state-regulated health plans, which would then be left with sicker, costlier enrollees, creating an uneven playing field and a segmented insurance market.

“If you’re a healthy small employer and you’re allowed to escape all these rules, you may be able to have lower premiums — until someone in your group gets sick,” said Lucia.

Solvency of the plans is a real concern as well, say analysts studying them, since the federal standards in the bill are generally less rigorous than rules from the states.

The flexibility that GOP lawmakers see in the bill might not serve workers well, said Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities.

“Right now there’s a fairly consistent set of rules of what a small group or individual plan has to look like in terms of benefits, costs and coverage,” she said. “If we’re talking about a world where none of that exists anymore — or an association health plan is outside of those standards — then as a consumer you’re dealing with a very confusing situation.”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Follow Michelle Andrews on Twitter: @mandrews110.

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Health Care Vote Showdown: Republicans Look to Go Big or Go Home

Another day, another chance to pass the Republican health care plan.

After a difficult Thursday for Republicans who had hoped to have passed their bill to repeal and replace the Affordable Care Act, aka Obamacare, the House is back at it again Friday — but this time with a directive from the White House that it’s now or never.

The House has scheduled a vote for their health plan, known as the American Health Care Act, for Friday afternoon. The postponement came after weeks of negotiations, which reached a breaking point Thursday as House leadership and the Trump administration seemed to be getting no closer to cobbling together the necessary 215 votes to pass the bill. Then President Donald Trump delivered a message to the House: If it doesn’t pass Friday, we’re moving on.

So House Republican leaders are moving forward with a vote on the American Health Care Act, regardless of whether they have the votes — a risk that could possibly deliver House Speaker Paul Ryan and President Trump a major defeat.

Of course, Republicans have been campaigning on repealing Obamacare since 2010, and Trump told his party members earlier in the week that reps could lose their seats if they don’t pass the GOP replacement plan.

But the hard sell wasn’t enough to convince those like Rep. Andy Biggs, R-Ariz., to climb on board. Late Thursday night he announced that he would vote against it, bringing NBC News’ tally of “no” or “leaning no” votes to 32.

“I cannot support anything less than a clean repeal of Obamacare,” Biggs said.

Image: Andy Biggs

Image: Andy Biggs

While the jockeying over what’s in the bill continued, so did persuasion tactics.

White House aides, most notably Steve Bannon, Trump’s chief strategist and senior adviser, spent the night working to convince the most conservative hold outs, telling them to “stand and deliver.”

And sources said that Trump told conservatives on Thursday that they’re asking for a lot, while he told moderates that they’ve already received a lot.

Most Republicans were pleased that the vote was set for Friday. Inside a Republican meeting Thursday evening, some members said that it’s time to vote and opponents would have to defend their positions.

Rep. Greg Walden of Oregon, the chairman of the House Energy and Commerce Committee who helped to usher the GOP health care plan through the drafting process, agreed with Trump’s decision to cut off negotiations.

“I think it was time to have pencils down — time to move forward,” Walden told reporters Thursday night.

But those undecided in their support of the AHCA were not necessarily ready to move forward so quickly.

“I always think if there’s any chance whatsoever that we can make the bill better then we should never stop negotiations,” said Rep. Trent Franks, an Arizona conservative who isn’t yet supporting the measure. “Now, there is a time that those negotiations should stop but let that not be arbitrary, let that be on the timetable itself.”

Image: House Republican conference meeting on the American Health Care Act

Image: House Republican conference meeting on the American Health Care Act

Trump’s ultimatum was made after a week of hard selling by the president that peaked on Thursday when he had meetings with both the Freedom Caucus — the conservatives — and the Tuesday Group — the moderates.

Friday morning, the president sought to remind the conservative faction of what they would be losing if the bill is defeated, tweeting:

Trump told Tuesday Group co-chair Rep. Charlie Dent, R-Penn., that he was “going to ruin the party,” according to a source. The source said Dent “was listening.”

Dent had come out against the bill because he said too many people would lose their Medicaid coverage and the tax credits to help people purchase insurance aren’t generous enough, especially for those aged 50 to 64.

Eleventh hour changes to the bill were made Thursday night — one more attempt to appease Republicans on both sides of the spectrum who weren’t yet on board.

Those changes include a temporary extension of a 0.9 percent Medicare tax on people making more than $200,000. That expected to raise $15 billion for the Patient and State Stability Funds to help pay for maternity and newborn care as well as mental health and substance abuse. It’s an effort to appease the moderates.

The other change would move the Essential Health Benefits from being a federal requirement and allow states to determine which ones they want to include in health insurance plans such as maternity care, hospitalization, emergency care and mental health services.

Related: Republican Health Care Vote: Everything You Need to Know

Those were just the latest round of changes that has been altered to appease the ideologically diverse caucus.

While the chance to make additional changes to the bill are over for the House, the White House and House leadership can still make future promises — something that has already been done through this process to get members on board.

Rep. Steve King of Iowa, for example, was promised that he would get a vote on a bill to ensure undocumented immigrants don’t receive tax credits for purchasing health insurance. And upstate New York lawmakers were given a change in the Medicaid allocation that enables their region to get a higher percentage, something that would take money away from New York City.

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House Republicans, Deeply Divided, Face Painful Choice on Health Vote

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Trump Tantrum looms on Wall Street if health-care effort stalls

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Donald Trump speaks at a campaign rally in Bloomington, Illinois, March 13, 2016.

The Trump Trade could start looking more like a Trump Tantrum if the new U.S. administration’s health-care bill stalls in Congress, prompting worries on Wall Street about tax cuts and other measures aimed at promoting economic growth.

Investors are dialing back hopes that U.S. President Donald Trump will swiftly enact his agenda, with a Thursday vote on a health-care bill a litmus test which could give stock investors another reason to sell.

“If the vote doesn’t pass, or is postponed, it will cast a lot of doubt on the Trump trades,” said the influential bond investor Jeffrey Gundlach, chief executive at DoubleLine Capital.

U.S. stocks rallied after the November presidential election, with the SP 500 posting a string of record highs up to earlier this month, on bets that the pro-growth Trump agenda would be quickly pushed by a Republican Party with majorities in both chambers of Congress.

The SP 500 ended slightly higher on Wednesday, the day before a floor vote on Trump’s health-care proposal scheduled in the House of Representatives.

Traders work on the floor of the New York Stock Exchange (NYSE) in New York City, U.S., November 7, 2016.

On Tuesday, stocks had the biggest one-day drop since before Trump won the election, on concerns about opposition to the bill.

Investors extrapolated that a stalling bill could mean uphill battles for other Trump proposals. Trump and Republican congressional leaders appeared to be losing the battle to get enough support to pass it.

Any hint of further trouble for Trump’s agenda, especially his proposed tax cut, could precipitate a stock market correction, said Byron Wien, veteran investor and vice chairman of Blackstone Advisory Partners.

“The fact that they are having trouble with (health-care repeal) casts a shadow over the tax cut and the tax cut was supposed to be the principal fiscal stimulus for the improvement in real GDP,” Wien said. “Without that improvement in GDP, earnings aren’t going to be there and the market is vulnerable.”

Strategists have been cautioning for weeks that markets are pricing in a scenario where nothing goes wrong with Trump’s agenda. Investors are paying $18.10 for every dollar in earnings expected on the SP 500 over the next 12 months, near the most expensive U.S. stocks have been since 2004.

“This is really about the fact that the market is pricing in too much certainty on a number of accounts,” said Julian Emanuel, executive director of U.S. equity and derivatives strategy at UBS Securities. “Even if you got the positive vote, there’s still the residual knowledge that the agenda will be difficult to get through the Senate.”

Market needs consolidation, currently very overbought: London Capital

While investors and strategists have said they do not see an immediate threat to the eight-year-old bull market, there is a risk of a 5-to-10 percent drop. Only a bear market — a 20 percent decline — would put an end to the bull.

“It looked like a mini tantrum,” said David Kotok, chief investment officer of Cumberland Advisors. “Trump has made the House vote his own now so he has a lot at stake. My guess it will pass the House. If not, markets will be shocked and it won’t be pleasant.”

Michael Arone, chief investment strategist at the US SPDR Business at State Street Global Advisors in New York said that it the health-care bill fails, “a correction of 5 percent is not unreasonable given how far we’ve come in such a short period of time.”

Focus on legislation

Investors are now more focused on the actual mechanics of the legislative process, said Brian Daingerfield, Macro Strategist at NatWest Markets.

“I noticed this was the first day (on Tuesday) I was getting inquiries about the health-care law and the vote count,” Daingerfield said. Wall Street views the health-care vote “as a test of Trump’s ability to unify the party,” he said. “It has a symbolic significance.”

After the health-care bill, the market will look for movement on tax and infrastructure. The president has said he wants the health bill passed by the mid-April Easter holiday and a schedule from the administration aims for tax reform being passed by August. Only then will they begin to tackle infrastructure spending.

“U.S. equities have been priced for perfection since the start of 2017 and (Tuesday) was a rude reminder that the legislative process is imperfect on even its best days,” said in a research note Nicholas Colas, chief market strategist at Convergex, a global brokerage company based in New York.


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Republican Health Care Vote: Everything You Need to Know

All eyes are on Congress today, where the House is scheduled to vote on the American Health Care Act (AHCA). It’s high legislative drama as Republican leaders still don’t know if they have the votes to pass the measure.

The bill, backed by President Donald Trump and House Speaker Paul Ryan, would partially repeal and replace the Affordable Care Act, aka Obamacare, and could dramatically impact health insurance for tens of millions of Americans. Here’s what you need to know about what the bill does and where it stands.

How does health care work now?

Let’s start with how things work under Obamacare. The ACA was primarily about fixing problems in the individual insurance market, which includes people who don’t get coverage through work or government programs. If you weren’t on the individual market, you might not have noticed the changes.

Under the old system, insurance companies could deny coverage to people with pre-existing conditions or charge higher premiums. Obamacare requires insurers to take on everyone, sick or healthy, and charge the same price for a comprehensive plan. To make sure the market isn’t flooded with only the most expensive patients, everyone is required to buy insurance or pay a penalty. To help people afford their plan, the law pays out subsidies to people making up to 400 percent of the federal poverty line. It also offers states more Medicaid dollars to cover adults at lower incomes.

How does the GOP plan change things?

On the surface, the House GOP bill has some similarities to Obamacare. It requires insurers to take on customers regardless of any pre-existing condition. It provides subsidies to people, in the form of tax credits, to buy insurance on the individual market. And it tries to encourage people to stay insured.

But the similarities end there.

The bill spends less on fewer subsidies, reduces Medicaid spending by large amounts, and uses the savings to eliminate taxes on wealthier Americans and medical companies imposed by the ACA. It would reduce the deficit by $337 billion over the next 10 years, according to the nonpartisan Congressional Budget Office.

Tell me more about how it works

First, the subsidies are different. If you qualify for help buying insurance under Obamacare, the government makes sure you don’t pay more than a certain percentage of your income, which starts at 3 percent at low incomes and tops out at 9.5 percent for higher incomes. If premiums go up, the subsidies go up, too. Some low-income beneficiaries get additional help with out-of-pocket costs.

Image: President Donald Trump and Health and Human Services Secretary Tom Price

Image: President Donald Trump and Health and Human Services Secretary Tom Price

Under the House bill, though, you get a fixed tax credit that’s based on your age, maxing out at $4,000 to start. If premiums are still too high to purchase insurance with that credit, you’re stuck.

Second, the Medicaid expansion would be phased out and the program would change so that the federal government only pays states a set amount per person. States could also opt to take their Medicaid dollars as a block grant. Some 14 million fewer people would receive Medicaid coverage under these changes, the CBO estimated.

Finally, Obamacare’s requirement to buy insurance is gone. In its place, insurers will be allowed to charge people 30 percent more on their premiums for one year if their coverage lapses.

Overall, the CBO estimates these changes would leave 24 million people without insurance by 2026 who would have it under Obamacare.

Who gets hurt? And helped?

Older patients with low incomes will see big spikes in their premiums along with higher deductibles and out-of-pocket costs, especially if they live in rural areas where care tends to be expensive. A 64-year-old making $26,500 would pay an average of $12,900 more per year in premium costs, according to the CBO, and their insurance would not cover as much.

This is due to several major AHCA provisions: First is the change to a fixed tax credit. Second, the bill allows insurers to charge older customers up to five times as much as younger ones (the current limit is three times). Third, the bill drops an Obamacare provision that subsidizes out-of-pocket costs for lower-income beneficiaries. The AHCA also allows insurers to sell plans that cover fewer expenses.

Related: House Freedom Caucus Says No

On the flipside, younger and relatively more affluent customers would see some new benefits. The GOP’s tax credits apply to people with incomes up to $75,000, which provides some aid to people who have seen their premiums go up in recent years but make too much to receive Obamacare benefits. Premiums will also go down for some younger customers, partly because older (and more expensive to insure) customers will no longer be able to afford insurance. If you want to see how the bill might affect you, the nonpartisan Kaiser Family Foundation has a handy interactive map.

As for the tax cuts, unless you’re a shareholder in the affected medical industries or make over $200,000 a year in income ($250,000 as a couple), they won’t affect you much. Seventy-nine percent of the tax cuts on high earners would go to millionaires, according to an analysis by the Center on Budget and Policy Priorities.

What do health experts think?

They mostly don’t like it, for a variety of different reasons. Many conservative experts on health policy are upset the GOP plan doesn’t include their proposals to reduce the cost of health insurance, some of which were left out for procedural reasons (more on that later) and others for political ones. Others think it’s too similar to Obamacare. Moderates and liberals want more spending to prevent people from losing coverage and don’t like that the bill boosts incomes for the rich while cutting aid to lower-income Americans.

Is this what Trump said he would do?

No. Trump ran on repealing Obamacare, but he distanced himself from other Republicans by promising his plan would provide “insurance for everybody,” lower deductibles and costs, and would not include Medicaid cuts. By any objective analysis, this bill would cover far fewer people than Obamacare, allow insurers to raise deductibles and out-of-pocket costs, and cut Medicaid by large amounts.

Will the bill pass today?

Good question — it’s going to be a tough vote.

There are two groups threatening to vote it down for different reasons: Conservatives and moderates. As of Wednesday night, at least 27 Republicans were either hard “no” or leaning “no” by an NBC News count. That would kill the bill as GOP leaders can afford only 22 defectors, since no Democrats are expected to support the bill.

Conservatives, led by the House Freedom Caucus, say the bill preserves too many elements of Obamacare for them to support it and many of the top advocacy groups on the right, like Heritage Action and Club For Growth, are egging them on. Many would prefer to repeal Obamacare entirely (or at least more of it) as a starting point rather than jump into a replacement immediately.

Moderates have the opposite concern. They worry the bill is too radical and that it cause millions to lose health insurance. Some are worried that its cuts to Medicaid will hurt their state budgets. Addressing their problems would mean further angering conservatives and vice versa.

That doesn’t mean the bill is dead, though. It’s difficult to vote against your own party’s president and Trump is aggressively pushing members to get on board.

On Wednesday night, House leaders and the White House were talking with the House Freedom Caucus about a possible deal to eliminate a major Obamacare provision called “Essential Health Benefits.” These are 10 broad categories of care, like hospitalization and maternity care, that the law requires insurers cover.

Conservatives want to drop these requirements, which would allow insurers to offer plans that cover fewer items but have more affordable premiums as a result. Critics are worried insurers will use these cheap plans to attract customers who are already healthy while customers with chronic health issues won’t be able to find an affordable plan that covers their needs. Politically, this issue could be more sensitive due to the current focus on the opioid addiction: EHB’s currently require plans to cover treatment for substance abuse.

It gets more complicated, though. House Republicans are using a procedure called budget reconciliation to pass the bill because it requires only a bare majority in the Senate, rather than 60 votes. The downside is that it limits what Congress is allowed to include in the bill. Initially House GOP leaders argued changes to Essential Health Benefits would not pass muster with the Senate parliamentarian, but they seem more willing to test the waters now.

What happens if it passes the House?

Then comes the Senate, where Majority Leader Mitch McConnell plans to quickly take it up. So far, it looks like an even tougher climb in the Senate.

The margin for error is slimmer than in the House: Republicans have 52 votes and can only lose two (Vice President Mike Pence would break a tie). There are conservative and moderate factions with serious concerns, but the moderates are considered a bigger obstacle on the Senate side versus the House.

Even then, things aren’t done. The White House says it will address various issues it can’t tackle in budget reconciliation through executive action and future legislation. But the prospects for these follow-up changes are also shaky: There’s limits on what the White House can do on its own (and potential lawsuits to overcome) and major follow-up legislation is unlikely to pass, since it would require Democratic support in the Senate.

What happens if the House doesn’t pass the bill?

If the House bill is defeated or withdrawn from a vote, Republicans will have some hard choices to make. The White House is refusing to even entertain that notion for now.

“We’re not looking at a Plan B,” White House spokesman Sean Spicer told reporters on Wednesday. “We have Plan A, it is going to pass, we are going to go from there.”

Trump warned House Republicans on Tuesday that they could lose their majority in 2018 if they fail to pass a health care bill.

Conservatives are hoping a failed vote would force Republican leaders to make fundamental changes to bring them on board, but then moderates would have the same demands from the other direction. It’s possible Trump and GOP leaders conclude there’s no viable bill that can unite the party for now and move on to their next priority, tax reform.

Trump himself has said in speeches that he was ambivalent about taking on health care and his initial instinct was to wait for Obamacare to encounter problems down the line that would force Democrats to come to the table.

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What the top US health official should be saying on vaccines

Health and Human Services Secretary Tom Price. (Joshua Roberts/Reuters)

During a televised town hall last week, the nation’s top health official was asked whether all children should get immunized for measles and other vaccine-preventable diseases. In his response, Health and Human Services Secretary Tom Price parsed his words carefully. He said state governments (presumably rather than the federal government) “have the public health responsibility to determine whether or not immunizations are required for a community population.”

His response angered many doctors and public-health officials, who say the top U.S. health official failed to give full-throated support for immunizations that prevent disease and protect communities at a time when anti-vaccine sentiment is on the rise.

Paul Sax, an infectious disease specialist at Boston’s Brigham and Women’s Hospital, said Price might have been choosing his words carefully for political reasons. Price, he noted, belongs to the Association of American Physicians and Surgeons, an organization that opposes mandatory immunizations. And there’s Price’s boss, President Trump, who has publicly expressed discredited concerns about vaccine safety.

So Sax decided to write tongue-in-cheek answers for what Price should be saying. The post appeared in a blog on HIV and infectious diseases in the New England Journal of Medicine.

In an interview, Sax said he wanted to highlight the opportunity Price missed to underscore the importance of these lifesaving medicines.

“It seems to me you have such a no-brainer situation with support for vaccines, and where the secretary of HHS could really rally behind that effort in a really strong way,” said Sax, who is medical director of Brigham’s infectious diseases division.

Here’s what Price said during a CNN town hall hosted by Wolf Blitzer:

Blitzer: Dr. Price, you’re a physician. You believe in immunizations. You believe all children should get a shot for polio and other diseases?

Price: The question that you asked is what kind of health care ought to be provided to individuals. And there are certain things that we do — ought to do as a society, and we encourage, that’s the kind of education that is so important for folks, so that they know what’s best for them and for their families.

Here’s what Sax wrote for Neo-Price (meaning a new, improved Price), that the HHS secretary should have said:

Blitzer: So you believe in immunizations, you believe all children should get a shot for polio, and other diseases?

Neo-Price: Absolutely. We in the Department of Health and Human Services strongly support the state policies that require childhood immunizations. These policies have had a miraculous effect in reducing illness and death, particularly in children, and greatly improve public health for all. Some prevent cancer. They even save money! Talk about a win-win-win-win.

Sax goes on to make up more follow-up answers to actual questions:

Blitzer: I hear there has been an increase in so-called “nonmedical vaccine exemptions” in the United States. What are your thoughts on these?

Neo-Price: Frankly, each nonmedical vaccine exemption is essentially a misguided, selfish decision made by a parent at the expense of both the child’s health and public health. They should be more than strongly discouraged — they should be abolished.

Blitzer: One last thing before you go — there are some who say the vaccine policies are being set by individuals who have hidden agendas — conflicts of interest with the pharmaceutical industry, or with insurance companies, or are just ivory tower academics who don’t understand “real” people.

Neo-Price: The Advisory Committee on Immunization Practices (ACIP) — which is organized by the Centers for Disease Control and Prevention, a wonderful government institution — is a prime example of how doctors, scientists, and public health officials can come together for the public good. They carefully review the vaccine safety and efficacy data, and then issue policies that are broadly endorsed. It’s about as good an example as you can find for your tax dollars well spent. Makes me tear up a bit with patriotism just thinking about it.

In the pretend question-and-answer, Sax also has Price explain why vaccination is important for everyone in the community, also known as herd community, with a short video.

Sax said he has received mostly positive comments, but most readers of his blog are infectious disease specialists and clinicians who already “get it,” he said. They know, Sax said, that one reason for a measles outbreak in Romania that has killed at least 17 people is the falling vaccination rates.

One doctor commenting on Sax’s blog said Price isn’t likely to read the posts. She called on every doctor who believes in science to email the blog post to him at

A spokesman for Price did not respond to a request for comment.

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The 6 dishes health nuts order at Olive Garden

Yes, you can have a hearty, healthy-ish meal at Olive Garden! Just watch out for words like “unlimited,” which pop up over and over on this menu — even too much salad and breadsticks can result in that over-stuffed feeling. And be wary of anything with pesto, garlic sauce, or alfredo, as those tend to be higher in fat and calories, Tara Collingwood, MS, RDN, official nutritionist for runDisney, told Fox News. Now go ahead and try one of these meals, approved by health nuts across the country!

Minestrone Soup and House Salad with Grilled Chicken
Olive Garden is known for its soup and salad, so here’s a version that amps up your meal’s nutrition. When you start with the minestrone soup, the lowest-calorie (110 per serving) soup on the menu, you may fill up and eat a smaller meal. “Studies have found that warm liquid calories are more filling than cold ones, which is great news if you love soup,” Maggie Moon, MS, RDN, author of “The MIND Diet,” told Fox News. As for the salad, request the dressing on the side — the fat it contains helps you absorb important vitamins, so go with a few drizzles. A side of grilled chicken adds lean protein to your meal. The soup-and-salad combo comes with breadsticks, but limit yourself to just one because each has 140 calories and 460 milligrams of sodium. “This meal still has a lot of salt, so drink plenty of water,” Moon advised.


Herb-Grilled Salmon
The salmon boasts heart-healthy omega-3 fats and is an excellent source of protein. Plus, the calories, fat, and sodium are lower than those of many other Olive Garden dishes. Order not one but two sides of broccoli because a double portion is only 40 calories yet provides 4 grams (16 percent of the daily value) of fiber, Tammy Lakatos Shames, RDN, and Lyssie Lakatos, RDN, dietitians, personal trainers, and co-authors of “The Nutrition Twins’ Veggie Cure, told Fox News. “Broccoli contains sulforaphane, which has been shown to prevent and fight a wide variety of cancers in test tube research,” they said.

Cucina Mia!
This “pasta your way” option lets you customize a healthier pasta bowl by choosing the type of pasta, sauce and protein. Opt for whole-grain linguine for extra fiber, marinara sauce in lieu of a creamy or oily one, and grilled chicken or sautéed shrimp for a lower-fat protein. Go with the shrimp option, and that’s 550 calories and 13 grams of fat for the whole dish. “If you overload your dish with heavy, creamy sauces and ingredients, you could be getting a lot of extra calories, fat and sodium,” Bonnie Taub-Dix, RDN, author of “Read It Before You Eat It,” told Fox News. Case in point: The asiago garlic alfredo sauce alone contains 940 calories and 91 grams of fat!


Cod Piccata
Here’s a dish that offers 37 grams of filling protein for 370 calories, one of the lowest entrée calorie counts on the menu. “Since the protein takes longer to digest than carbohydrate-filled meals, it tides you over longer and helps to keep hunger at bay,” The Nutrition Twins said. Lower the saturated fat by asking the kitchen to go lighter on the butter — and do the same with the salt for a lower-sodium dish.

Chicken Margherita
Ask for a lunch portion of this grilled chicken dish, and you’re looking at a meal for 370 calories. You also get a hearty serving of protein, at well over half the daily value. While the sodium content isn’t low, at 700 milligrams, it is one of the lowest-sodium counts on the menu.


Linguine di Mare
You get close to a day’s worth of protein and more than half a day’s worth of fiber from this 570-calorie dish that’s a mix of shrimp, mussels, whole-grain linguine and tomato sauce. “It’s one of the best choices on the dinner menu for balanced nutrition,” Moon said. The dish is higher in sodium and added sugar, so balance out the rest of your day with low-sugar and low-sodium home-cooked meals.

Amy Gorin is freelance writer and owner of Amy Gorin Nutrition in Jersey City, NJ. Connect with her on Facebook, Instagram, Twitter, and Pinterest.

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