Lawmakers address concerns over future of health insurance

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Unquestionably, the ACA has helped some people, but it has not come close to reaching the two goals supporters promised: coverage for everyone and decreasing health care costs.

Concerns about New Yorkers losing health insurance dominated much of the discussion, which focused on the fact that a record-high 3.6 million enrolled in 2017 coverage through NY State of Health, the state's Affordable Care Act, or ACA, marketplace.

Stevenson said there's lots of talk about having the free market take care of the problem of health care financing, but he pointed out that doesn't really work so well when you're the only game in town. But repeated promises by Republican lawmakers to dismantle the health care law, and Trump's signing of an executive order designed to restrict enforcement of the law's provisions, created uncertainty surrounding the ACA.

"It is hard to imagine a major overhaul being in place anytime very soon", said Katherine Baicker, a health economist at the Harvard T.H. Chan School of Public Health.

Bertolini said mounting financial losses of $450 million in Affordable Care Act business forced Aetna's decision previous year to cut its participation in health care exchanges in hundreds of counties. In Blount County, the number of participating insurers started with three in 2014, grew to four in 2015, dropped back to three in 2016 and dropped to only one in 2017.

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This means that Republicans, while waiting for their alternative to "congeal", have already set in motion the disintegration of the current health-insurance market.

"If repeal and replace can not be accomplished simultaneously, the reductions to rural hospitals should be restored to ensure we have sufficient resources to provide care to the uninsured", McMillan said. "It's the dog who somehow is now driving the vehicle".

Take Sen. Ron Johnson (R-Wis.), who in 2011 called Obamacare "the single greatest assault on our freedom in my lifetime".

There may be different paths to achieving these health care goals.

Then there's Rep. Tom McClintock (R-Calif.).

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Whether to keep the Medicaid expansion that was part of Obamacare could divide conservative and moderate Republicans.

It's still not known what a replacement program would look like and what it would cover, though last month Trump said his plan would provide "insurance for everyone". "They're unable to continue to go to school and the disconnect is that the cost to the community when we sort of ignore these ongoing issues is they end up in homeless shelters, they end up in jail". It is unclear which elements of this system could survive in the Republican replacement.

The past year has been a rocky one for the landmark health reform law.

Dana Milbank is a columnist for The Washington Post.

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