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“Obviously it’s an improvement, but I think that it is inadequate given the health care crisis that we’re in,” said Representative Ro Khanna, a progressive Democrat from California who favors the single-payer, government-run system called Medicare for All that has been embraced by Senator Bernie Sanders, independent of Vermont, and the Democratic left.

“We’re in a national health care crisis,” Mr. Khanna said. “Fifteen million people just lost private health insurance. This would be the time for the government to say, at the very least, for those 15 million that we ought to put them on Medicare.”

The stimulus bill would make upper-middle-income Americans newly eligible for financial help to buy plans on the federal marketplaces, and the premiums for those plans would cost no more than 8.5 percent of an individual’s modified adjusted gross income. It would also increase subsidies for lower-income enrollees.

Just when Mr. Biden or Democrats would put forth such a plan remains unclear, and passage in an evenly divided Senate would be an uphill struggle. White House officials have said Mr. Biden wants to get past the coronavirus relief bill before laying out a more comprehensive domestic policy agenda.

The Affordable Care Act is near and dear to Mr. Biden, who memorably used an expletive to describe it as a big deal when he was vice president and President Barack Obama signed it into law in 2010. It has expanded coverage to more than 20 million Americans, cutting the uninsured rate to 10.9 percent in 2019 from 17.8 percent in 2010.

Even so, some 30 million Americans were uninsured between January and June 2020, according to the latest figures available from the National Health Interview Survey. The problem has only grown worse during the coronavirus pandemic, when thousands if not millions of Americans lost insurance because they lost their jobs.

Mr. Biden made clear when he was running for the White House that he did not favor Medicare for All, but instead wanted to strengthen and expand the Affordable Care Act. The bill that is expected to reach his desk in time for a prime-time Oval Office address on Thursday night would do that. The changes to the health law would cover 1.3 million more Americans and cost about $34 billion, according to the Congressional Budget Office.

Republicans have always said that their plan was to repeal and replace the health law, but after 10 years they have yet to come up with a replacement. Mr. Ayres said his firm is working on “coming up with some alternative health care message” that does not involve “simply throwing everybody into a government-run health care problem.”

Yet polls show that the idea of a government-run program is gaining traction with voters. In September, the Pew Research Center reported that over the previous year, there had been an increase, especially among Democrats, in the share of Americans who say health insurance should be provided by a single national program run by the government.

“I would argue there is more momentum for Medicare expansion given the pandemic and the experience people are having,” said Mr. Khanna, the California congressman. “They bought time, but I think at some point there will be a debate on a permanent fix.”

WASHINGTON — President Biden’s $1.9 trillion coronavirus relief bill will fulfill one of his central campaign promises, to fill the holes in the Affordable Care Act and make health insurance affordable for more than a million middle-class Americans who could not afford insurance under the original law.

Under the changes, the signature domestic achievement of the Obama administration will reach middle-income families who have been discouraged from buying health plans on the federal marketplace because they come with high premiums and little or no help from the government.

“For people that are eligible but not buying insurance it’s a financial issue, and so upping the subsidies is going to make the price point come down,” said Ezekiel Emanuel, a health policy expert and professor at the University of Pennsylvania who advised Mr. Biden during his transition.

But because those provisions last only two years, the relief bill almost guarantees that health care will be front and center in the 2022 midterm elections, when Republicans will attack the measure as a wasteful expansion of a health law they have long hated. Meantime, some liberal Democrats may complain that the changes only prove that a patchwork approach to health care coverage will never work.

The Affordable Care Act is near and dear to Mr. Biden, who memorably used an expletive to describe it as a big deal when he was vice president and President Barack Obama signed it into law in 2010. It has expanded coverage to more than 20 million Americans, cutting the uninsured rate to 10.9 percent in 2019 from 17.8 percent in 2010.

The poll found that 36 percent of Americans, and 54 percent of Democrats, favored a single national program. When asked if the government had a responsibility to provide health insurance, either through a single national program or a mix of public and private programs, 63 percent of Americans and 88 percent of Democrats said yes.

Just when Mr. Biden or Democrats would put forth such a plan remains unclear, and passage in an evenly divided Senate would be an uphill struggle. White House officials have said Mr. Biden wants to get past the coronavirus relief bill before laying out a more comprehensive domestic policy agenda.

Republicans have always said that their plan was to repeal and replace the health law, but after 10 years they have yet to come up with a replacement. Mr. Ayres said his firm is working on “coming up with some alternative health care message” that does not involve “simply throwing everybody into a government-run health care problem.”

In January, he ordered the Affordable Care Act’s health insurance marketplaces reopened to give people throttled by the pandemic economy a new chance to obtain coverage.

Yet polls show that the idea of a government-run program is gaining traction with voters. In September, the Pew Research Center reported that over the previous year, there had been an increase, especially among Democrats, in the share of Americans who say health insurance should be provided by a single national program run by the government.

With its expanded subsidies for health plans under the Affordable Care Act, the coronavirus relief bill makes insurance more affordable, and puts health care on the ballot in 2022.

cludes rich new incentives to entice the few holdout states — including Texas, Georgia and Florida — to finally expand Medicaid to those with too much money to qualify for the federal health program for the poor, but too little to afford private covera

“Biden promised voters a public option, and it is a promise he has to keep,” said Waleed Shahid, a spokesman for Justice Democrats, the liberal group that helped elect Representative Alexandria Ocasio-Cortez and other progressive Democrats. Of the stimulus bill, he said, “I don’t think anyone thinks this is Biden’s health care plan.”

“I think that argument has been fought and lost,” said Whit Ayres, a Republican pollster, conceding that the repeal efforts are over, at least for now, with Democrats in charge of the White House and both houses of Congress.

That was before more than 68,000 people in the United States tested positive for the coronavirus, grinding the country to a halt, upending lives from coast to coast, and postponing primary elections in many states. The virus has made the stakes, and the differing visions the two parties have for health care in America, that much clearer.

“Sometimes these health care debates can get a bit abstract, but when it’s an immediate threat to the health of you and your family, it becomes a lot more real.”

While the Democrats spent much of their primary fighting about whether to push for “Medicare for all” or build on the Affordable Care Act, the coronavirus crisis may streamline the debate to their advantage: At a time when the issue of health care is as pressing as ever, they can present themselves as the party that wants people to have sufficient coverage while arguing that the Republicans do not.

“A crisis like the coronavirus epidemic highlights the stake that everyone has in the care of the sick,” said Paul Starr, a professor of sociology and public affairs at Princeton who served as a health policy adviser in the Clinton White House. “It really strengthens the Democratic case for expanded health coverage, and that should work, I should think, to Biden’s advantage in a campaign against Trump.”

The virus is also having dire economic consequences, depriving Mr. Trump of a potent re-election argument rooted in stock market gains and low unemployment numbers. It is testing Mr. Trump’s leadership in the face of a national emergency like nothing he has encountered, and if voters give him poor marks, that could inflict lasting damage on his chances in November’s general election.

Four years ago, Mr. Trump ran for president promising to repeal the Affordable Care Act, popularly known as Obamacare. But his campaign pledge quickly turned into a debacle in the first year of his presidency when Republicans struggled and ultimately failed to repeal and replace the health law. In the midterm elections the next year, Democrats emphasized health care, highlighting issues like preserving protections for people with pre-existing conditions, and they won control of the House.

Mr. Trump is particularly vulnerable on the issue of health care. Over the course of his presidency, his administration has repeatedly taken steps to undermine the Affordable Care Act, including by arguing in court that the entire law should be invalidated. The Supreme Court agreed this month to hear an appeal in that case, which is the latest major challenge to the law. The court is not expected to rule until next year, but Democrats point to the Trump administration’s legal position as yet another example of the president’s desire to shred the Affordable Care Act.

In his campaign, Mr. Biden has already put a focus on health care, promising to build on the Affordable Care Act and create a so-called public option, an optional government plan that consumers could purchase. On the campaign trail, he has talked about his own exposure to the health care system

In the Democratic primary race, the health care debate has largely focused on the divide between moderate-leaning Democrats looking to build on the Affordable Care Act and progressives calling for Medicare for all, a government-run health insurance program. Mr. Biden and Mr. Sanders represent the two sides of that argument.

In a poll this month by Morning Consult, four in 10 Americans said the coronavirus outbreak had made them more likely to support universal health care proposals in which everyone would receive their health insurance from the government.

The cost: The participating counties and municipalities are contributing to a $4bn statewide spend, including Miami Beach’s $400m Forever Bond, a $1bn stormwater plan and $250m of improvements to Broward county’s sewage systems to protect against flooding and seawater seepage. In the Keys, many consider the estimated $60m a mile cost of raising roads too expensive.

The threat: Saltwater from sea level rise is seeping further inland through Florida’s porous limestone bedrock and contaminating underground freshwater supplies, notably in the Biscayne aquifer, the 4,000-sq mile shallow limestone basin that provides drinking water to millions in southern Florida. Years of over-pumping and toxic runoff from farming and the sugar industry in central Florida and the Everglades have worsened the situation. The Florida department of environmental protection warned in March that “existing sources of water will not adequately meet the reasonable beneficial needs for the next 20 years”. A rising water table, meanwhile, has exacerbated problems with south Florida’s ageing sewage systems. Since December, millions of gallons of toxic, raw sewage have spilled on to Fort Lauderdale’s streets from a series of pipe failures.

The cost: The Everglades restoration plan was originally priced at $7.8bn, rose to $10.5bn, and has since ballooned to $16.4bn. Donald Trump’s proposed 2021 federal budget includes $250m for Everglades restoration. The estimated $1.8bn cost of the reservoir will be split between federal and state budgets.

Possible solutions

The cost: With homeowners and businesses largely bearing their own costs, the specific amount spent on “hurricane-proofing” in Florida is impossible to know. A 2018 Pew research study documented $1.3bn in hazard mitigation grants from federal and state funding in 2017, along with a further $8bn in post-disaster grants. Florida is spending another $633m from the US Department of Housing and Urban Development on resiliency planning.

Wildlife and habitat loss The threat: Florida’s native flora and fauna are being devastated by climate change, with the Florida Natural Areas Inventory warning that a quarter of the 1,200 species it tracks is set to lose more than half their existing habitat, and the state’s beloved manatees and Key deer are at risk of extinction. Warmer and more acidic seas reduce other species’ food stocks and exacerbate the deadly red-tide algal blooms that have killed incalculable numbers of fish, turtles, dolphins and other marine life. Bleaching and stony coral tissue disease linked to the climate crisis threaten to hasten the demise of the Great Florida Reef, the only living coral reef in the continental US. Encroaching saltwater has turned Big Pine Key, a crucial deer habitat, into a ghost forest.

As for the Key deer, of which fewer than 1,000 remain, volunteers leave clean drinking water to replace salt-contaminated watering holes as herds retreat to higher ground. A longer-term debate is under way on the merits and ethics of relocating the species to other areas of Florida or the US.

Coastal erosion The threat: Tourist brochures showcase miles of golden, sandy beaches in South Florida, but the reality is somewhat different. The Florida department of environmental protection deems the entire coastline from Miami to Cape Canaveral “critically eroded”, the result of sea level rise, historically high tides and especially storm surges from a succession of powerful hurricanes. In south-eastern Florida’s Palm Beach, Broward, Miami-Dade and Monroe counties, authorities are waging a continuous war on sand loss, eager to maintain their picture-perfect image and protect two of their biggest sources of income, tourism dollars and lucrative property taxes from waterfront homes and businesses.

In the devastating hurricane season just one year before, major storms named Harvey, Maria and Irma combined to cause damage estimated at $265bn. Scientists have evidence the climate crisis is causing cyclones to be more powerful, and intensify more quickly, and Florida’s position at the end of the Atlantic Ocean’s “hurricane alley” makes it twice as vulnerable as any other state.

With the other option abandoning beaches to the elements, city and county commissions have little choice but costly replenishment projects with sand replacement and jetty construction. Federal law prohibits the importation of cheaper foreign sand, so the municipalities must source a more expensive alternative from US markets, often creating friction with residents who don’t want to part with their sand. Supplementary to sand replenishment, the Nature Conservancy is a partner in a number of nature-based coastal defense projects from West Palm Beach to Miami.

benefited from 61,000 cubic yards of new sand this year at a cost of $16m. Statewide, Florida spends an average $50m annually on beach erosion.

The threat: “Climate gentrification” is a buzzword around south Florida, a region barely 6ft above sea level where land has become increasingly valuable in elevated areas. Speculators and developers are eyeing historically black, working-class and poorer areas, pushing out long-term residents and replacing affordable housing with upscale developments and luxury accommodations that only the wealthy can afford.

No study has yet calculated the overall cost of affordable housing lost to the climate crisis. Private developers will bear the expense of mitigating the impact on the neighborhood – $31m in Magic City’s case over 15 years to the Little Haiti Revitalization Trust, largely for new “green” affordable housing. The University of Miami’s housing solutions lab has a $300,000 grant from JPMorgan to report on the impact of rising seas to South Florida’s affordable housing stocks and recommend modifications to prevent it from flooding and other climate events. A collaboration of not-for-profit groups is chasing $75m in corporate funding for affordable housing along the 70-mile south Florida rail trail from Miami to West Palm Beach, with the first stage, a $5m project under way to identify, build and renovate 300 units.

Florida has long been plagued by political leadership more in thrall to the interests of big industry than the environment. As governor from 2011 to 2019, Rick Scott, now a US senator, slashed $700m from Florida’s water management budget, rolled back environmental regulations and enforcement, gave a free ride to polluters, and flip-flopped over expanding offshore oil drilling. The politician who came to be known as “Red Tide Rick”, for his perceived inaction over 2018’s toxic algae bloom outbreaks, reportedly banned the words “climate change” and “global warming” from state documents.

Last month, state legislators approved the first dedicated climate bill. It appears a promising start for a new administration, but activists say more needs to be done. In January, the Sierra Club awarded DeSantis failing grades in an environmental report card, saying he failed to protect Florida’s springs and rivers and approved new roads that threatened protected wildlife.

The cost: Florida’s spending on the environment is increasing. The state budget passed last month included $650m for Everglades restoration and water management projects (an instalment of DeSantis’s $2.5bn four-year pledge) and $100m for Florida Forever. A $100m bridge project jointly funded by the state and federal governments will allow the free flow of water under the Tamiami Trail for the first time in decades.

Florida has woken up to the threat of climate change but it is not yet clear how effective the response will be. The challenges are innumerable, the costs immense and the political will to fix or minimize the issues remains questionable, despite recent progress. At stake is the very future of one of the largest and most diverse states in the nation, in terms of both its population and its environment. Action taken now will determine its survival.

The Least Affordable Neighborhood in the U.S.? From the report: "In the Philadelphia region, moderate-income households are faced with average housing and transportation costs exceeding 90 percent of their income in some neighborhoods."

The Price of Density: Housing in Houston isn't so bad -- it's the 8th most affordable large city to own a home in. But the same thing that helps make it an affordable place to own a home (lots of space!) also raises its commuting costs. Factor in transportation, and it's the 8th least affordable large city to live.

dense expensive cities like San Francisco, Boston and New York are considerably more affordable when you add in transportation costs because of their superior public transit.

Nationwide, Housing Grew 2X as Fast as Income: Combined H&T expenses average $30,296 for a median-income household, according to the report. But they're growing much faster than median household income.

The need to bolster the Affordable Care Act will become even more urgent, the coalition says, if Texas and other states succeed in their lawsuit to invalidate the entire law.

Yet another Democratic proposal, allowing states to create a Medicaid buy-in program for all their residents, regardless of income, has won support from 23 senators, including Mr. Booker, Mr. Brown, Ms. Gillibrand, Ms. Harris, Ms. Klobuchar and Ms. Warren.

And “during the whole debate over the Affordable Care Act, we supported having a public option in the individual insurance market in every state,” said Robert B. Doherty, senior vice president of the college, which represents 154,000 doctors who specialize in internal medicine.

instructs the Department of Health and Human Services to open a special enrollment period for the Affordable Care Act through HealthCare.gov,

"As we continue to battle COVID-19, it is even more critical that Americans have meaningful access to affordable care," a White House fact sheet reads.

His second executive action aims "to protect and expand access to comprehensive reproductive health care" by rescinding the Mexico City policy, also known as the global gag rule. This policy, reinstated and expanded by the Trump administration, bars international nongovernmental organizations that provide abortion counseling or referrals from receiving U.S. funding. Biden on Thursday called the gag rule an "attack on women's health access."

For decades, Democratic and Republican presidents have alternately rescinded or reinstated the global gag rule, with Democrats, such as Biden, opposing the policy. Republicans have argued that the rule would reduce the number of abortions.

The Supreme Court will hear a case that could decide the legality of work requirements for Medicaid recipients.

Biden is reversing course and directing federal agencies to reconsider those work requirement rules. He is also asking agencies to review policies that undermined protections for people with preexisting conditions, including complications related to COVID-19.

The administration faced pressure to open HealthCare.gov for anyone to enroll in the Affordable Care Act in response to the pandemic, but it never did.

Last November, the Trump administration and several Republican-led states argued at the U.S. Supreme Court that the program should be voided, which would have eliminated popular elements of the law such as protections for those with preexisting conditions.

However, a study released last year suggested the policy failed to reduce the rate of abortions and ultimately had the opposite effect. The study said the rate of abortions increased by about 40% in the countries studied — most likely because the funding ban caused a reduction in access to contraception and a consequent rise in unwanted pregnancies.

Under the actions announced on Thursday, the president is telling federal agencies to review a Trump-era rule that limited the use of Title X federal funds meant for family planning and reproductive health services for low-income patients. Under this program, organizations that provided abortions or abortion counseling could not have access to those federal funds. The White House said, "Across the country and around the world, people — particularly women, Black, Indigenous and other people of color, LGBTQ+ people, and those with low incomes — have been denied access to reproductive health care."

Rather than provide housing for the homeless, cities offer showers, day care centers and bag checks.

We have decided to live with the fact that some of our fellow Americans will die on the streets.

“There’s a cruelty here that I don’t think I’ve seen,” Leilani Farha, then the United Nations special rapporteur on adequate housing, said after a 2018 visit to Northern California.

“I’ve never seen anything like it, and I’ve done outreach on every continent,” Dame Louise Casey, who directed homeless policy for several British prime ministers, said after touring homeless encampments in San Francisco, Los Angeles and other American cities.

almost 40 percent of workers in households making less than $40,000 a year have lost work. Women in Need NYC, which runs shelters, warned this week that New York faces a “mass increase” in homelessness

Countries confronting homelessness with greater success than the United States, including Finland and Japan, begin by treating housing as a human right

the first law of real estate applies to homelessness, too: Location, location, location. The nation’s homeless population is concentrated in New York, the cities of coastal California and a few other islands of prosperity.

Well-educated, well-paid professionals have flocked to those places, driving up housing prices. And crucially, those cities and their suburbs have made it virtually impossible to build enough housing to keep up.

The government calculates $600 is the most a family living at the poverty line can afford to pay in monthly rent while still having enough money for food, health care and other needs. From 1990 to 2017, the number of housing units available below that price shrank by four million.

While there are roughly 80,000 homeless people in New York on any given night, more than 800,000 New Yorkers — more than 10 times as many people — are scraping by, spending more than half their income on rent.

According to one analysis, a $100 increase in the average monthly rent in a large metro area is associated with a 15 percent increase in homelessness.

In 2018, eight out of every 10,000 Michigan residents were homeless. In California, it was 33 per 10,000. In New York, it was 46 per 10,000.

in recent decades, wealth and homelessness have both increased — a stark illustration of the inequalities that pervade American life.

Having failed to address homelessness during the longest economic expansion in American history, the nation now faces a greater challenge under more difficult circumstances

Reframing the debate — asking what is necessary to end homelessness — is an important first step for New York and for other places that are failing this basic test of civic responsibility.

The program costs about $19 billion a year. Vouchers for all eligible households would cost another $41 billion a year

Where to get the money? Well, the government annually provides more than $70 billion in tax breaks to homeowners, including a deduction for mortgage interest payments and a free pass on some capital gains from home sales. Let’s end homelessness instead of subsidizing mansions.

Without a significant expansion in the supply of housing, adding vouchers would be like adding players to a game of musical chairs without increasing the number of chairs.

Market-rate construction can help: More housing would slow the upward march of housing prices. New York and San Francisco are the nation’s most tightly regulated markets for housing construction,

Tokyo, often cited as an international model for its permissive development policies, has expanded its supply of homes by roughly 2 percent a year in recent years, while New York’s housing supply has expanded by roughly 0.5 percent a year. Over the last two decades, housing prices in Tokyo held steady as New York prices soared.

In California, for example, construction of a five-story apartment building that meets minimum standards costs an average of $425,000 per unit,

Without public aid, the apartments would need to be rented for several times more than the $600 a month affordable to a family living at the poverty line.

Proposals for a big increase in affordable housing construction inevitably call to mind the troubled public housing projects of the mid-20th century. They offer one clear lesson: Avoid housing that concentrates poverty

there is a solution — to build subsidized housing as part of mixed-income developments and to spread the developments out, putting them not just in cities but also in the surrounding suburbs.

Helsinki, Finland, a city of just 600,000 people, builds about 7,000 units of mixed-income housing a year. That’s a big reason Finland is the rare European country where homelessness is in decline.

Extending this approach to the entire homeless population would be expensive. To take one example, King County, which encompasses Seattle, would need to increase annual spending on homelessness to roughly $410 million from $196 million to help each of the county’s 22,000 homeless families, according to a study by McKinsey. That’s about $19,000 per family.

Even if the cost per person were twice as high, the nation’s homeless population could be housed for $10 billion a year — less than the price of one aircraft carrier.

there is worse to come. Homelessness rises during recessions, the federal funding is temporary and state and local governments face huge drops in tax revenue.

The federal government already provides housing vouchers to help some lower-income families. The families pay 30 percent of their monthly income toward rent; the government pays the rest. But instead of giving vouchers to every needy family, the government imposes an arbitrary cap. Three in four eligible families don’t get vouchers.

Americans must decide whether we are willing to let elementary school students spend nights in guarded parking lots

We must decide whether it’s worth spending just a little of this nation’s vast wealth to ensure that no 60-year-old woman needs to sleep on the same bench in downtown Santa Monica

Households in all five boroughs needed to be pulling in at least $100,000 to afford housing, food and transportation, and to have a shot at being able to plan for the future

In southern Manhattan, home to some of the most expensive ZIP codes in the country, families with two adults and two children needed to make at least $150,000 combined

The actual median household income in the city was hovering around $70,000

a considerable majority of households that could not keep up with the cost of living — 80 percent — had at least one working adult, and more than half of New Yorkers who could not make ends meet had a college degree or some college credit, if not a graduate degree.

The affordability crisis is particularly urgent for nonwhite New Yorkers, the study found. Latino, Black and immigrant New Yorkers were bearing the brunt of the affordability crisis, and residents of the central Bronx had the highest rates of economic instability.

And more than 85 percent of households where single mothers were taking care of young children were unable to keep up with the cost of living

the news of premium hikes will work in his favor, though his criticism in reaction to news has revealed more about the limitations of his own policy knowledge than anything about how he’d fix the problem.

For one: The administration’s announcement is a mere formalizing of increases many people familiar with the industry predicted throughout the year.

If Trump is indicative, Republican politicians don’t have the language to capitalize on some of the weaknesses of the law right now. Over the past two years, neither their calls for blanket repeal of Obamacare, nor the coverage of historic gains in insurance coverage, have meaningfully altered public opinion one way or the other.

Only a small sliver of the population is enrolled through the exchanges, and most people in the country are covered through their employers, where premiums have risen at rates similar to previous years.

The federal government will protect most Americans from the real financial impacts of a spike in premiums, and only between five and seven million people will bear the full sticker shock of Obamacare premium hikes.

Additionally, most people with subsidized coverage who are directly threatened by the loss of Aetna or other major insurers won’t have to go shopping for new plans until 2017.

he future of the Affordable Care Act isn’t even the top health care issue for registered voters, but that finding comes with a few grains of salt. Sixty-six percent of those polled viewed the future of Medicare as a non-exclusive “top priority,” with an equal proportion viewing access and affordability of health care as such.

Proposals like Donald Trump’s that involve remaking a system that is just beginning to settle have challenges with winning over many people who actually have to navigate the changes involved.

So what’s left for Republicans and Donald Trump? Probably not another health-reform-fueled revolution. It’s unlikely that premium increases can influence enough lives now to provide that kind of momentum at the polls, and Trump’s incoherence looks more like a last-ditch gambit than legitimately savvy capitalization on what appear to be real problems with the law.

Americans are seeking affordable ways forward with what they have in ways that disrupt their lives the least. For now, their response is probably not panic

But Obama has largely remained silent. That should not come as surprise. His reticence reflects one of the problems that constrained his presidency—his hesitation and resistance to getting down and dirty in the muck of partisan politics. He aimed high, but American politics went low.

But when it came to partisan politics, Obama declined to enter into bare-knuckled combat with Tea Party Republicans. He bowed out of the fight at the exact time that he was requiring congressional Democrats to vote on a series of highly controversial issues.

Obama’s strategy of trying to deflate his opposition by downplaying or hiding the impact of his programs posed political problems for his political supporters. Democrats wanted Obama to wave the flag of victory, but the president believed that avoiding drama was a better approach. As the president expanded the federal government with a hidden hand, refusing to boast of the effects of the stimulus or downplaying discussions about what his regulatory changes achieved (a sharp contrast from President Trump), Democrats didn’t have as much to work with on the campaign trail.

When Obama became president in 2009, Republicans could afford to have former President George W. Bush sit on the sidelines as they rebuilt their strength. Unlike Obama, Bush was hugely unpopular. But more importantly, the right had its institutions as a solid base for revival. The grassroots energy of the Tea Party was connected to these entrenched institutions, from Fox News to Dick Army’s FreedomWorks. But the Democratic Party can’t afford to wait; it needs Obama to learn from one of the great mistakes of his own presidency: his failure to take seriously enough the grave political threat his party was facing.

The last time Obama was too timid, the Republicans roared. His party can’t afford to see Obama make that same mistake once again.

“We haven’t given up on changing the American health care system,” Senator Mitch McConnell of Kentucky, the majority leader, said after a lunchtime meeting of Republican senators. “We are not going to be able to do that this week, but it still lies ahead of us, and we haven’t given up on that.”

Mr. McConnell said Republicans would move on to their next big legislative goal: overhauling the tax code, a feat that has not been accomplished since 1986.

Democrats, who have spent all year fighting to protect the Affordable Care Act, a law that is a pillar of President Barack Obama’s legacy, responded by calling for the resumption of bipartisan negotiations to stabilize health insurance markets.

“We hope we can move forward and improve health care, not engage in another battle to take it away from people, because they will fail once again if they try,” said Senator Chuck Schumer of New York, the Democratic leader.

The decision by Senate Republican leaders may prove to be a milestone in the decades-long fight over health insurance in the United States, suggesting that the Affordable Care Act had gained at least a reprieve and perhaps a measure of political acceptance.

health care is sure to be an issue in next year’s midterm elections.

For their part, Democrats have tried to use health care as a bludgeon against the few Senate Republican targets they have next year, mainly Senators Dean Heller of Nevada and Jeff Flake of Arizona.

“We know Republicans like Dean Heller and Jeff Flake won’t stop until they force Americans to pay more for less, and we will make sure voters hold them accountable for it,”

The Graham-Cassidy bill would have taken money provided under the Affordable Care Act for insurance subsidies and the expansion of Medicaid and sent it to states in the form of block grants.

President-elect Biden’s inclusion of policies to shore up the health law in his first major legislative package has raised those hopes further.

“We’re talking about improving affordability after not being able to have that conversation for years.”

One conducted in 2018 shows that 42 percent of those who shopped for individual market coverage found it “very difficult or impossible to find an affordable plan.”

The Biden plan would create a new cap — 8.5 percent of an individual or family’s income on premium contributions — for midlevel health plans, something the president-elect had also proposed during the campaign. This policy would mostly affect higher-earning Americans who do not currently qualify for subsidies.

The Center on Budget and Policy Priorities estimates that a family of four earning $110,000 would see monthly premiums for a midlevel health plan fall to $779 from $1,529.

These are low-income Americans, who make up the majority of those who still lack coverage in the United States. These people already receive help buying coverage, but are still left with paying a monthly premium share that can be unaffordable.

Numerous academic studies show that premium subsidies are the strongest driver of health law enrollment. Experts say this type of large increase, directed toward low-income Americans, could drive millions more to sign up.

“It’s important both in terms of helping people through this crisis, and as a sign of the seriousness with which he is considering the future of improvements to the Affordable Care Act,” she said. “This is a step in the right direction, and it’s certainly consistent with the bigger vision he campaigned on.”

"It's even worse than what passed out of the Republican House last Congress," the aide said. "The whole notion of that sort of block granting idea just rips out even more of the protections."

House Republicans are rolling out their complex plan as Trump struggles to articulate broad ideas for the nation's health care, and as Democrats campaign across the country on an easy-to-explain vision for extending coverage to everyone.

That plan -- so far a patchwork quilt of health care proposals that Trump's team hopes will stack up to a comprehensive vision -- will serve as the White House's answer to the growing support on the left for the kind of universal health care system that Republicans have spent years warning against.

"The White House welcomes the RSC announcement and their contributions to improving our healthcare system," Judd Deere, White House spokesman, told CNN. "The Trump Administration continues to work to improve healthcare more broadly, which includes creating a system that protects the vulnerable and those with pre-existing conditions and delivers the affordability Americans needs, the choice and control they want, and the quality they deserve."

The House GOP plan comes against the backdrop of a court case that has the potential to upend the nation's health insurance system and the 2020 election campaign. Federal appellate court judges in Louisiana are now considering a case brought by a coalition of Republican-led states, and backed by the Trump administration, that argue Obamacare as a whole is unconstitutional because Congress essentially eliminated the penalty for not having health insurance, the so-called individual mandate. A US District Court judge in Texas in December sided with the Republican states.

The Trump administration has chosen not to defend the law, leaving many Republicans concerned that they will not have a replacement ready if the appellate court upholds the lower court's ruling. Democrats are already attacking Trump and the GOP for threatening the coverage of millions of Americans, and if the court invalidates the ACA, Republicans could be left with the blame for dismantling the country's health care system without preparing a realistic replacement.

"Do you want a president who wants to have the government take over your health care, or do you want personal choices?" Marshall said Monday. "So even though there's impeachment and all those other things going on here, I think this -- healthcare -- is the issue of 2020."

"I had to pray that my insurance would approve of my transplant just in the nick of time," she says. "I had that Stage 4 label attached to my name and that has dollar signs. Who wants to invest in someone with stage four?"

After doing her research, Rafieei says she intends to vote for Joe Biden, who helped get the ACA passed in this first place.

Even ten years after the Affordable Care Act locked in a health care protection that Americans now overwhelmingly support — guarantees that insurers cannot deny coverage or charge more based on preexisting medical conditions — voters once again face contradicting campaign promises over which candidate will preserve the law's legacy.

A majority of Democrats, Independents and Republicans say they want their new president to preserve the ACA's provision that protects as many as 135 million people from potentially being unable to get health care because of their medical history.

President Donald Trump has pledged to keep this in place, even as his Administration heads to the U.S Supreme Court the week after Election Day to argue the entire law should be struck down.

And yet the Trump administration has not unveiled a health care plan or identified any specific components it might include. In 2017, the administration joined with Congressional Republicans to dismantle the Affordable Care Act, but none of the GOP-backed replacement plans could summon enough votes. The Republicans' final attempt, a limited "skinny repeal" of parts of the ACA, failed in the Senate because of resistance within their own party.

But the state's governor also embraced the Republican effort to repeal and replace the law in 2017, and now Arizona's Attorney General is part of the lawsuit — that will be heard by the Supreme Court on Nov. 10 — that could topple the entire law.

Republicans have often tried to skirt health care as a major issue this election cycle because there isn't the same political advantage to pushing the repeal and replace argument, says Mark Peterson, a professor of public policy, political science and law at UCLA.

"Not everybody, particularly Republicans, associates the ACA with protecting preexisting conditions," he says. "But it is pretty striking that overwhelmingly Democrats and Independents do — and a number of Republicans — that's enough to give a significant national supermajority."

Trump's appointment of a new Supreme Court justice marks the third of his tenure in office, giving Republicans a historic opportunity to deliver on the key conservative priority and campaign promise of transforming the federal courts through lifetime appointments.

Barrett, who is 48 years old, is likely to serve on the court for decades and will give conservatives a 6-3 majority on the Supreme Court, a shift in its makeup that could have dramatic implications for a range of issues that could come before it, including the future of the Affordable Care Act and any potential disputes regarding the 2020 election.

They moved to confirm Barrett over the objections of Democrats who have argued that the process has been a rushed and cynical power grab that threatens to undermine Ginsburg's legacy.

Senate

Senate Republicans, who hold a majority in the cham

Senate Republicans, who hold a majority in the chamber, pushed ahead with one of the quickest nomination proceedings in modern times following the death of the late Justice and liberal icon Ruth Bader Ginsburg last month

"By any objective standard, Judge Barrett deserves to be confirmed to the Supreme Court. The American people agree. In just a few minutes, she'll be on the Supreme Court," Senate Majority Leader Mitch McConnell said ahead of the final confirmation vote

The confirmation battle has played out in a bitterly-divided Senate, but the outcome has not been in question for much of the fight. With few exceptions, Senate Republicans quickly lined up in support of Barrett after her nomination by President Trump, while Democrats united in opposition.

Two Republican senators crossed party lines to vote with Democrats in opposition to a key procedural vote on Sunday -- Collins and Lisa Murkowski of Alaska.Murkowski announced that she would ultimately vote to confirm Barrett in the final vote

Senate Republicans largely rallied around the nomination, however, praising Barrett as exceedingly qualified to serve on the Supreme Court

Senate Democrats, in contrast, have decried the nomination and the confirmation process. Democrats have warned that Barrett's confirmation will put health care protections and the Affordable Care Act in jeopardy. They have argued that the confirmation process has been rushed and accused Republicans of hypocrisy in moving ahead with the nomination after blocking consideration of former President Obama's Supreme Court nominee Merrick Garland in 2016.

Democrats, who are in the minority, have been limited in their ability to oppose the nomination, but have protested the process in a variety of ways.

When the Senate Judiciary Committee voted to advance the nomination, Democratic senators on the panel boycotted the vote, filling their seats instead with pictures of people who rely upon the Affordable Care Act in an effort to draw attention to an upcoming case on the health care law's constitutionality and their arguments that Barrett's confirmation would put the law at risk.

During confirmation hearings, Democrats sought to elicit answers from Barrett on a number of controversial topics the Supreme Court could take up. Barrett repeatedly declined, however, to specify how she might rule on a range of topics, from the Affordable Care Act to Roe v. Wade and the high court's ruling legalizing same-sex marriage.

Barrett explained during the hearings that she shared a philosophy with the late conservative Justice Antonin Scalia, whom she clerked for, but argued she would not be an identical justice if she is confirmed.

Democratic states and the House, which intervened in the case to defend the health law, asked the Supreme Court to intervene, saying a prompt decision was needed to remove the uncertainty caused by the lower courts’ decisions.

In a 2017 law review article, she questioned the chief justice’s 2012 opinion. “Chief Justice Roberts pushed the Affordable Care Act beyond its plausible meaning to save the statute,” Justice Barrett wrote.In an interview after the 2015 decision, she said, “I think the dissent has the better of the legal argument.”“That’s not to say the result isn’t preferable,” Judge Barrett said at the time. “It’s clearly a good result that these millions of Americans won’t lose their tax subsidies.”

Tens of millions of Americans gained insurance coverage under the 2010 law, which includes popular provisions on guaranteed coverage for pre-existing medical conditions, emergency care, prescription drugs and maternity care. Republican state officials, backed by the Trump administration, say that a key provision of the law is unconstitutional, and that this means the whole law must fall.

The law’s defenders are hoping that the Republican challengers cannot run the table on three separate legal arguments they would need to win: that they have suffered the sort of injury that gives them standing to sue; that the zeroing out of the tax penalty made the individual mandate unconstitutional; and that the rest of the law cannot stand without the individual mandate.

The Republicans also face the challenge of the enormous practical effects of striking down the law. Doing so would increase the ranks of the uninsured in the United States by more than 20 million people — a nearly 70 percent increase — according to new estimates from the Urban Institute.

The biggest loss of coverage would be among low-income adults who became eligible for Medicaid under the law after all but a dozen states expanded the program to include them. But millions would also lose private insurance, including young adults whom the law allowed to stay on their parents’ plans until they turned 26 and families whose income was modest enough to qualify for subsidies under the law that help pay their monthly premiums.

Tuesday’s arguments, which will be heard by telephone, are scheduled for 80 minutes but are likely to last two hours or longer. Michael J. Mongan, the solicitor general of California, representing a coalition of liberal-leaning states, will defend the law; Kyle D. Hawkins, the solicitor general of Texas, representing a coalition of conservative-leaning states, will urge the justices to strike it down.

“It may not get approved the first time, and it may not get approved the second time, but the Democrats who will try not to approve it” will be at risk, he said,

He described the health law as a catastrophe. “I feel that repeal and replace have to be together, for very simply, I think that the Democrats should want to fix Obamacare,”

After meeting with House Republicans on Tuesday, Mr. Ryan took a similar tone, calling the campaign to repeal the health law “a rescue mission to save families who are getting caught up in the death spiral that has become Obamacare.”

That legislation would take Democratic cooperation to be passed, because Senate Republicans are eight votes short of a filibuster-proof majority.

Far from a “death spiral,” Mr. Obama and congressional Democrats call the Affordable Care Act the best health law since the creation of Medicare and Medicaid in 1965.

Obama administration reported on Tuesday that more than 11.5 million people nationwide had signed up for health insurance or been automatically re-enrolled under the Affordable Care Act as of Dec. 24, 2016.

ut a seemingly insatiable demand for luxury condos in Miami, created in part by wealthy Latin Americans, has caused land prices to soar, making affordable housing projects harder to build anywhere close to downtown. Moving farther out is cheaper, but the cost savings on housing can be quickly wiped out by transportation costs. A 2012 study by the Center for Housing Policy found that Miami was the most expensive metropolitan area in the country when housing and transportation costs were combined.

n many markets, buying a home is considerably cheaper than renting, and Miami is no exception. But many people are shut out of buying because their income is too low, they don’t qualify for a mortgage or they are burdened by other debt. In 2008, a quarter of rental applicants were still paying off student loans, according to CoreLogic, but as of last fall half of them were doing so.