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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

they believe it even though there is no clear example of a modern health care system built along the lines that they desire.

The dominant systems in the developed world, whether government-run or single-payer or Obamacare-esque, are generally statist to degrees that conservatives deplore.

As the conservative policy thinker Yuval Levin wrote late last year, the striking thing about Obamacare to date is how much smaller than expected its effect on the overall health care system has been. Fewer people are being insured on the exchanges than liberals hoped, fewer employers are dumping high-cost employees onto the exchanges than conservatives feared

There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow, and good reasons to think that free-market competition produces more medical innovation than more socialized systems.

embracing even the smartest conservative Obamacare alternative requires a not-precisely-Burkean leap of faith.

this is the advantage of Cassidy-Collins: It encourages governors and legislators to actually put the conservative theory of health care to the test without simply reversing the ideological colors of the great Obamacare experiment and immediately turning the entire United States health care system over to the right’s technocratic vision.

mostly they tend to be much more heavily regulated and subsidized than the system that conservative health policy wonks and policy-literate Republicans would like to see take over from Obamacare.

he writes:The extremely serious problems we are seeing now are within the one system that Obamacare created from scratch, the exchange system. That system may not survive, and its condition has a lot to teach us about the problems with liberal health economics. But it is a much smaller system than anyone thought it would be at this point, about half the size that C.B.O. projected, so that the effects of any failure it suffers are likely to be more contained than anyone might have expected.

If the Obamacare exchanges aren’t ultimately going to work out, then allowing them to persist in liberal states while an alternative system gets set up in red states is a reasonable way to gradually transition from the liberal model toward the conservative one. If the right’s wonks are right about health policy, the Cassidy-Collins approach should — gradually — enable conservatives to prove it.

if the right is wrong, if its model doesn’t match reality, if people are simply miserable as health care consumers because the system has too much of Friedman and not enough of Burke — well, in that case both the country and conservatism will be better off if we learn that via a voter rebellion in 10 right-leaning states, rather than through a much more widespread backlash against a nationwide health-insurance failure

The latest Wikileaks dump shows that Clinton’s own inner circle was worried about her dissembling and reluctance to apologize over the email mess, even as the campaign ripped the press for raising those questions. --The media are a bit bored with the story line that she’s clobbering him and want the race to tighten.

But now we have Podesta himself and former Clinton aide Neera Tanden writing frankly about Hillary’s penchant for secrecy and terrible political judgment.

Podesta ripped two longtime loyalists, lawyer Cheryl Mills and spokesman Philippe Reines, along with Clinton attorney David Kendall, for not being “forthcoming on the facts.”

This roller-coaster campaign has a couple of twists and turns left, and that’s not good news for the woman who many in the media are ready to inaugurate.

When the press was harping on the fact that Clinton would not apologize for having a private server, and campaign officials were pushing back hard, it turns out that some privately agreed with the critics.

“Everyone wants her to apologize. And she should. Apologies are like her Achilles heel.”

The disclosure that ObamaCare premiums are rising an average of 25 percent—more in some states, less in others—has provided a measure of vindication for the program’s conservative detractors. It has also given Trump, who wants to repeal ObamaCare, new ammunition against Clinton, who wants to reform it—in part by increasing government subsidies.

The steep premium hikes, and dwindling insurance options in some areas, make clear that President Obama oversold the program.

Now Trump clearly bobbled a statement about his own employees being affected by ObamaCare—only a small percentage are, his company pays the rest—but that doesn’t neutralize the larger issue.

he press has been hungry for a new story line so people don’t check out in the final two weeks. The Wikileaks dump, ObamaCare news and some tightening polls in Florida are all it takes. Perhaps the media will shelve the speculation about Clinton’s Cabinet and treat this once again as a horse race.

I do not see them fleeing in large numbers.”

premiums are set to rise an average of 25 percent next year. The selection of health plans on the exchanges is also shrinking.

Customers bolting the exchanges won’t necessarily avoid the rising premiums by shopping “off-marketplace.”

The big downside to shopping off the exchanges is that customers would not receive insurance subsidies. But for customers who wouldn’t qualify for subsidies anyway, shopping off the exchanges potentially gives them more options – including, in some cases, cheaper plans.

a total of 6.9 million people are getting insurance in the individual market outside the exchanges.

about 11.1 million people are enrolled in ObamaCare exchange plans, with 9.4 million of them getting premium subsidies.

HHS report seemed to be nudging people back toward the exchanges, noting that roughly a third of those avoiding the exchanges potentially could qualify for subsidies.

“millions of them may qualify for financial assistance that would let them purchase coverage and health care at lower cost” if they returned to the ObamaCare fold.

millions of them may qualify for financial assistance that would let them purchase coverage and health care at lower cost” if they returned to the ObamaCare fold.

Both marketplaces, for example, require covering individuals with pre-existing conditions.

The estimated number of insurance providers available on the exchanges for next year is 167, a net decrease of 68.

The decline in choice alone could result in more consumers leaving, even if they have to pay higher costs outside the market, in order to keep their doctor.

The HHS study noted that some of the 6.9 million shopping off-market also could qualify for Medicaid programs, which were expanded in many states.

Just for 2016, we know rates are going up in exchange plans,

White House press secretary Sarah Sanders said the decision was "based on guidance from the Justice Department."

"It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America," said Senate Minority Leader Chuck Schumer and House Minority Leader Nancy Pelosi in a joint statement. "Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it."

This was the second major move on Obamacare Thursday. Earlier in the day, Trump signed an executive order charging his administration with developing policies to increase health care competition and choice in order to cut prices. However, it could also destabilize Obamacare by siphoning off younger and healthier Americans from the exchanges.

What will Congress do?

"Cutting health care subsidies will mean more uninsured in my district. @POTUS promised more access, affordable coverage.," Florida Rep. Ileana Ros-Lehtinen, a Republican who will be retiring at the end of this term, said in a Twitter post after the news broke Thursday night. "This does opposite."

"Under no circumstance should Congress attempt to expand Obamacare by cutting a check for President Obama's bailout of insurance companies," tweeted GOP Rep. Mark Walker of North Carolina. "Instead, Congress must fulfill the promise to repeal and replace Obamacare with high-quality, patient-centered health care."

Will costs go up?

Insurers have already signed contracts committing them to participating in 2018 and setting their rates. They must continuing offering the reduced deductibles and co-pays to eligible enrollees, but they won't be paid for them. That's why many asked for such large rate hikes.

Obamacare enrollees eligible to receive premium subsidies, which are not affected by Trump's move, will continue to get discounted rates.

Still, leadership’s plan to keep the bill hidden until the last possible moment before a markup, move it through committees as quickly as possible and get it to the floor before the end of the month could work ― especially if only a handful of Republicans have the mettle to buck Trump.

If it dropped the employer mandate, the Obama White House would be fully committed to a more disruptive future, in which exchanges and subsidies gradually replaced the employer-based system.  And since those exchanges and subsidies are going to be implemented by this administration no matter what — barring a Martian invasion or a zombie apocalypse, at least — the sooner we find out if they really work and what they really cost the better.

“if you like Obamacare, and you want it to work, you don’t need the employer mandate.” And if you don’t like Obamacare (as Roy doesn’t), and don’t expect it to work, then all the mandate does is delay a necessary reckoning with the new system’s flaws.

Either way, the White House’s decision is a step toward honesty in policy-making. It takes us a little closer to a world where politicians of both parties actually level with the public, and acknowledge that employer-provided health insurance is an idea whose time has passed.

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.

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.”

r premiums, the Medicare cuts, the Medicaid expansion, all of it. And at that point, the plausible right-of-center alternatives to Obamacare will no longer look risky and disruptive relative to the status quo, because that status quo will no longer be one that Republican interests and voters are deeply invested in defending. Instead, those interests and voters will be looking for ways to limit the health care law’s impact, and the conservative alternatives will look more like what they actually are — proposals that spend less, regulate less, and reflect a greater confidence in markets than the president’s new law, and that would change the underlying health care system in ways that a sensible G.O.P. should support.

the bulk of these Republicans no longer believe in the Republican party. They identify more strongly with the Tea Party or Evangelical groups or Fox News than the GOP. On social issues, the defining issue is homosexuality – not abortion. That intransigence will alienate them them even further from the future mainstream. Their next big issue: denying climate change

The bewildering economic and social and demographic changes have created a cultural and existential panic among those most heavily concentrated in those districts whose members are threatening to tear down the global economy as revenge for losing two presidential elections in a row. They feel they have already lost and have nothing to gain from any constructive engagement with a president they regard as pretty close to the anti-Christ of parasitic minorities. They feel isolated in a more multi-cultural country. They feel spied upon and condescended to. They have shut out any news sources apart from Fox. It does not occur to them, for example, that Obamacare might actually help them. And you get no actual specifics on policies they like or dislike. It is all abstractions based on impressions.

you have to see the bigger cultural and religious picture when analyzing what has happened to American conservatism these past two decades or so

I see no way to integrate these groups and people into the broader body politic or conversation. Their alienation is so deep it is close to unbridgeable. And further defeats will make their isolation worse, not better, their anger more, not less, intense.

without strong economic growth, it is hard to see how it can be ameliorated in the near future.

I fear it will get even worse than this until it gets better.

Conservatives agree that these cheaper plans create more risk. But they also create a sensitivity to price — and with it, a curb on cost growth — that’s rare in a system where third-party payment has made prices opaque, arbitrary and inflated.

for a society that pretty clearly spends far too much on health care, sticking with catastrophic coverage frees up money — thousands for individuals and families, billions for the government — to spend on something other than the insurance-medical complex.

This is why the law’s critics believe Obamacare might be a long-term failure even if it survives its launch troubles and works on its own terms for a while. It’s not about the good things the reform delivers: those are real enough. It’s about whether there are too many other goods, for too many people, that the law’s three “mores” end up crowding out.

Additionally, Republican governors have mostly been slow to expand Medicaid coverage to low-income residents of their states or have declined to do so at all, decisions that have both decreased the number of potentially satisfied Clinton voters with new coverage and further destabilized markets and prices. The study finds that had Georgia, Florida, North Carolina, and Wisconsin embraced Medicaid expansion or even pursued slightly less-obstructionist policies, it could very well have tipped those states—and the 2016 election—to Clinton.

it does suggest a link between health care and voting that experts have long observed. A series of election studies by Harvard researcher Robert Blendon illustrates that while health care isn’t always a major factor in elections, in the cycles when it does rise to be a top priority for many voters, dissatisfaction with costs is the main driver of their decisions. Notably, it doesn’t really matter if voters’ personal costs have really increased; what matters is that they believe prices are rising.

the delay might accelerate the unraveling of employer-sponsored health coverage:If you like Obamacare, and you want it to work, you don’t need the employer mandate. Democrats put the employer mandate in Obamacare because the President was worried that, without a mandate, employers would dump coverage, violating his oft-repeated promise that “if you like your plan, you can keep it.

(the “American Job Protection Act”) is that one can very easily imagine it being taken up by left-wing Democrats as well as right-wing Republicans, albeit for different reasons.

delaying the employer mandate could lead, ultimately, to its repeal, which would do much to transition our insurance market from an employer-sponsored one to an individually-purchased one.

If the employer mandate were to ultimately be repealed, or never implemented, today’s news may turn out to be one of the most significant developments in health care policy in recent memory.

Even if the Obama administration’s delay lasts for only one year, that delay will give firms time to restructure their businesses to avoid offering costly coverage, leading to an expansion of the individual insurance market and a shrinkage of the employer-sponsored market.

If we transition from employer-provided coverage to tightly-regulated state-based insurance markets, it is possible that the insurance business will become even more rigid than it already is — this is why I’ve called for a national exchange as a kind of escape hatch. And of course if the private insurance market becomes more dysfunctional, a single-payer, Medicare-for-all alternative will become more politically attractive.