House Obamacare repeal bill faces long odds in the Senate

Senate Majority Leader Mitch McConnell of Kentucky speaks to reporters on Capitol Hill on Tuesday. (Photo: Pablo Martinez Monsivais)

WASHINGTON — House Republicans defied the odds and narrowly passed a controversial bill to repeal and replace Obamacare on Thursday afternoon, with House Speaker Paul Ryan urging his members to seize the moment and deliver on their long-held campaign promise even before members received an estimate of the bill’s effects from the Congressional Budget Office.

It took many late night meetings, last-minute amendments and old fashioned arm-twisting to push the bill through the House, but the American Health Care Act likely faces an even steeper and more treacherous climb in the staid and slow Senate.

Factions of both moderate and conservative GOP senators are deeply skeptical of the bill for entirely different reasons, making a path forward they can all agree upon difficult to imagine. The Republicans’ bare majority — just 52 votes — means they can only lose two senators and still push a repeal through. The chamber’s Democratic senators remain firmly unified against any repeal of Obamacare.

Even if Republican senators do find that path, they are unlikely to accede to House conservatives’ demands that they return the precariously negotiated legislation back to them virtually untouched. Rep. Dave Brat, R-Va., a member of the Freedom Caucus, said Tuesday the Senate better not change the AHCA “one iota,” or risk losing support. But several Republican senators said Thursday they expected to write their own, improved bill after reviewing the House version.

“When the House passes a bill, I’ll review it and then we’ll go to work on the Senate bill,” said Sen. Lamar Alexander, R-Tenn.

“The Senate will have its own bill, I don’t think this is the final product,” Sen. Bill Cassidy, R-La., said.

Several GOP senators also expressed concerns with the rushed process in the House, which voted on the revised bill less than 24 hours after posting it. Members also voted on the bill before receiving a new Congressional Budget Office estimate of its cost and effects. A previous score from the nonpartisan office estimated that 24 million people would lose insurance coverage under the original AHCA plan over 10 years. Several tweaks were made to win over support from the Freedom Caucus, the group of hardline conservative members who balked and refused to support that version of the bill.

House Speaker Paul Ryan leaves a meeting at the Capitol before the vote to repeal Obamacare. (Photo: Kevin Lamarque/Reuters)

The Senate will almost certainly consider the bill at a slower pace, with a vote on likely happening in July at the earliest — right before the body’s monthlong August recess.

“Any bill that’s been posted less than 24 hours, going to be debated three or four hours, and not scored needs to be viewed with suspicion,” Sen. Lindsey Graham, R-S.C., said Thursday morning.

Sen. Susan Collins, R-Maine, said she wanted to see a CBO score of the House version before starting work on a Senate bill.

“It’s very difficult for me to analyze the bill in the absence of a CBO score,” Collins said.

The Senate couldn’t skip the CBO score step even if it wanted to, since the Republican leadership is attempting to pass the sweeping health care changes through reconciliation — a process that takes just a bare majority instead of 60 votes to advance. Senate rules require a CBO score for any bill passed through reconciliation.

Senate Minority Leader Chuck Schumer, D-N.Y., also seems poised to put up a fight over the reconciliation process, saying Wednesday on the Senate floor that portions of the bill “very possibly” violate the Byrd Rule, which prohibits bills that would significantly increase the federal deficit beyond a 10-year term from passing through reconciliation. Schumer argued that portions of the House bill dealing with preexisting conditions would increase the deficit.

Meanwhile, spokespeople for two Republican senators who had earlier expressed concerns that the AHCA cuts coverage for Medicaid recipients in their states say they still remained opposed. Kevin Smith, spokesman for Sen. Rob Portman, R-Ohio, said the senator “has concerns that this bill does not do enough to protect Ohio’s Medicaid expansion population, especially those who are receiving treatment for heroin and prescription drug abuse.” Ashley Berrang, spokeswoman for Sen. Shelley Moore Capito, R-W.V., said the AHCA “still does not address the concerns Sen. Capito has voiced throughout this debate.” Berrang said Capito would work to improve the bill in the Senate.

Medicaid remains a huge stumbling block for the bill going forward. The CBO estimated that the previous version of the AHCA would cut Medicaid by $880 billion over 10 years. Republican senators in states that have expanded Medicaid under Obamacare could face blowback from their constituents if they back these cuts. But keeping Medicaid expansion would likely alienate more conservative Republicans who say the government can’t afford the increased Medicaid and should repeal Obamacare altogether. Sen. Rand Paul, R-Ky., for example, opposed the previous version of the AHCA and called for a “clean repeal” of Obamacare in March with a replacement to come at a later date. Paul and other Senate conservatives like Ted Cruz, R-Texas, remain wildcards going forward.

On Thursday, Paul told reporters he had “fundamental problems” with the AHCA because it directs taxpayer money to insurance companies. But the senator said he remained open to voting yes if the bill can be changed to be more conservative. “If we can bring the bill in our direction I’m still open-minded,” Paul said.

Summarized by Maven Stark


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Obamacare replacement bill revealed

House Speaker Rep. Paul Ryan, R-Wisc., opens a joint session of the U.S. Congress on Feb. 28, 2017, in the U.S. Capitol, before President Trump’s address. (Win McNamee/Getty Images)

WASHINGTON — House Republicans released their replacement for the Affordable Care Act on Monday night, backing off some ideas that caused controversy in their caucus, such as taxing high-dollar health benefits that employees obtain through their employers.

The bill, which Republicans will continue to revise in committee, repeals Obamacare’s individual mandate. Instead, people who do not make sure they are covered for two months or more in the year before they want to buy health insurance will pay 30 percent higher premiums for a year. This penalty is intended to encourage people to maintain insurance coverage without the mandate. The bill also doles out age-based tax credits to people making less than $75,000, to help them purchase insurance, instead of the income-based subsidies allocated under Obamacare.

The bill retains two popular features of Obamacare: one requiring insurance companies to insure people with pre-existing conditions, and another allowing young adults to remain on their parents’ insurance plans until they are 26 years old.

But the bill repeals most of the taxes imposed under Obamacare, including one on medical devices and another on indoor tanning services, which raises the question of how the bill will be paid for. The bill also avoids the “Cadillac tax” on premium employer health plans, after conservatives complained about any bill that creates new taxes.

Republicans compromised on the hot-button issue in the bill: Medicaid expansion. The 31 states that expanded Medicaid access under Obamacare will be allowed to continue to enroll new people until 2020. They will then be required to stop offering expanding Medicaid, with the hope that some people will leave the program and that it will shrink. States that did not expand Medicaid will receive $2 billion.

The bill faces a potentially rocky road ahead, with conservatives in the caucus sure to raise questions about how the bill will be paid for, and Democrats protesting that some Americans will lose coverage.

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Sanders, Cruz debate Obamacare: CNN's Reality Check Team vets the claims

Sens. Bernie Sanders and Ted Cruz debated the future of health care in the US Tuesday night, and CNN's Reality Check Team vetted the claims.

The team of reporters, researchers and editors across CNN listened throughout the event and analyzed key statements, rating them true, misleading or false.

Reality Check: Cruz on the cost of developing new drugs

By Kate Grise, CNN

During a CNN debate, Senator Ted Cruz called on Senator Bernie Sanders to join him in an effort to take on the pharmaceutical industry and reform the drug approval process at the Federal Drug Administration.

"Right now, it takes $2 billion to approve a new drug," Cruz said. "I've written legislation to reform the process so we can be curing diseases and curing people."

There is some controversy surrounding this figure.

The number Cruz refers to comes from a report by the Tufts Center for the Study of Drug Development which found it can cost an estimated $2.6 billion to develop a new prescription medicine that is approved by the FDA, according to a 2014 report.

That figure includes both 'out-of-pocket costs' like research and development and 'time costs,' or expected returns that investors forego while a drug is in development. The researchers estimated out-of-pocket costs to be $1.4 billion and time costs to be $1.2 billion.

The estimate was heavily criticized by Doctors Without Borders which called it inflated, and insisted that new drugs can be developed for $50 million to $186 million.

"If you believe that, you probably also believe the earth is flat," Rohit Malpani, director of Policy and Analysis for Doctors Without Borders said in a statement.

The Tufts researchers estimated that the cost to develop a new drug and get FDA approval has more than doubled since their last analysis in 2003.

As the Washington Post noted back in 2014, other studies put the cost of developing a drug anywhere between a 2006 estimate of approximately $800 million to a Forbes analysis of drug companies that put it as high as $5 billion.

While there is much debate on the actual costs of developing drugs, there are some estimates that project the costs to be more than $2 billion for each new drug developed. We rate Cruz's claim as true.

Reality Check: Cruz says 70% of counties in America, on Obama exchanges, have a choice of one or two health insurance plans

By Tami Luhby, CNNMoney

Senator Ted Cruz blasted Obamacare for driving Insurers out of the individual market.

"...in 70 percent of the counties in America, on Obamacare exchanges, you have a choice of one or two health insurance plans, that's it, 70 percent of the counties in America," he said.

Many insurers have left the exchanges for 2017. Several major players, including Aetna and UnitedHealth, downsized their participation after losing hundreds of millions of dollars.

According to Kaiser Family Foundation, 68% of counties have only one or two insurers in 2017. So we rate Cruz's claim as true.

Reality Check: Sanders on universal health care

By Debra Goldschmidt, CNN

"The United States is the only major country on earth not to guarantee health care to all people as a right," Sanders said.

This is something that Sanders also said previously throughout his presidential campaign.

The World Health Organization issued a report in 2014, saying, "the USA is currently the only high-income country without nearly universal health-care coverage."

As we determined before, based on the WHO report, our verdict is true.

Reality Check: 'Overwhelming majority' want to improve, not repeal Obamacare, Sanders says

By Eve Bower, CNN

Describing public opinion about Obamacare, also known as the Affordable Care Act, Sanders said, "the overwhelming majority of the American people say, 'Do not simply repeal the ACA, make improvements.' "

Recent polls support this claim.

A CNN/ORC poll taken in the second week of January found a large majority of Americans are opposed to a simple repeal. Fifty-five percent supported repealing parts of the law if -- and only if -- a replacement could be enacted at the same time. More than one-fifth of Americans (22%) want Republicans to abandon all plans to repeal, and leave the existing ACA in effect.

A survey taken after the election and published in December 2016 by the Kaiser Family Foundation, showed only 26% of Americans favor repealing the ACA in full. Of the remaining three-quarters who do not support repeal, the overwhelming majority do say they support making changes to the law -- though they define these changes differently: 30% of those surveyed hoped to expand on the existing ACA; 17% wanted to scale back on what the ACA does.

Just 19% wanted to keep the ACA in its present form.

We rate Sanders' claim as true.

Reality Check: FDA too slow to approve new cancer drugs for children, Cruz says

By John Bonifield, CNN Health

"In the last 20 years, the FDA has approved only three child cancer drugs. In 20 years. Because the burdens are so great," Cruz said.

The three drugs approved by the Food and Drug Administration are Clolar, approved in 2004, Erwinaze (2011), and Unituxin (2015).

"The reason there's only been three is the number of kids getting cancer is small, and it's been difficult to attract companies to develop drugs for the small number of kids needing them," said Dr. Otis Brawley, chief medical officer for the American Cancer Society. "It's very difficult to make a profit."

Only about 15,000 children develop cancer a year, Brawely said, and 60% do "really well" on currently available therapies. They represent less than 1% of all cancers, meaning there's fewer patients to study as drug makers work on new treatments.

So while it's true there have been few drugs approved for childhood cancers, it's false to blame that all on the burden of government.

Reality Check: Sanders on uninsured Americans

By Kate Grise, CNN

"When you have 28 million people who have no health insurance, that's rationing," Sanders said. "When you have people who can't afford to go to the doctor or can't afford to buy prescription drugs -- one out of five Americans can't afford the prescription drugs their doctors prescribe -- that's called rationing, except there's no rule on that. There's no law on that. It's just people don't have the money to buy what they need."

According to data from the National Health Interview Survey, 28.4 million Americans were uninsured in 2016.

Previously, 44.8 million Americans were uninsured in 2013, according to NHIS data. The percentage of Americans who were uninsured dropped from 16% in 2010 to 8.9% in the first half of 2016.

Kaiser Family Foundation reported that of those still uninsured at the end of 2015, 46% said they did not get coverage because it was too expensive.

We rate Sanders' claim that 28 million Americans do not have health insurance as true.

Sanders went on to say that "one out of five Americans can't afford the prescription drugs their doctors prescribe."

That number is a little high. According to the 2013 National Health Interview Survey, almost 8% of adults did not take their medications as the doctor prescribed in order to save money.

Researchers from Washington State University found similar results. Just under 8% of Americans aged 26 to 64 were unable to afford their prescriptions in 2014, according to the study published in the American Journal of Public Health in 2016. And overall, by 2015, 5.2% of Americans did not fill a prescription because they could not afford it.

We rate Sanders' claim that 20% of Americans can't afford their prescription drugs as false.

Reality Check: Cruz on part-time employees and Obamacare

By Ashley Strickland, CNN

Cruz said there has been an increase in part-time employees due to employers who don't want to provide Obamacare.

Answering a question from a business owner, Cruz referred to employees affected by the health care rules as "29ers" and "49ers."

"29ers are the millions of people across this country that have been forced into part-time work that used to have full-time employment and are now working 29 hours a week because Obamacare kicks in at 30 hours a week. And a lot of them are people -- they're single moms, teenagers, immigrants and they're people who are struggling."

"And 49ers, there are millions of small businesses in the exact situation you're in. A couple months ago, I was in West Texas, was visiting a dairy farmer, driving around the dairy farm. But the farmer brought up, he said, 'You know how many employees I have?' I said I don't know. He said, 'I've got 49.' He said, 'You know why I have 49?' And I said yes, I do. 'Cause Obamacare kicks in at 50. And he said, 'I could hire 20 or 30 more employees right now, but Obamacare would bankrupt my business.' "

Cruz was referencing the Affordable Care Act provision that requires employers with at least 50 full-time employees to offer health benefits.

Only 2% of employers said they changed or planned to change some employees from full-time to part-time and remove their eligibility for health benefits, according to the 2016 Kaiser Family Foundation/HRET Employer Health Benefits Survey.

Meanwhile, 7% of employers changed or planned to change some of their employees from part-time to full-time so that they would be eligible or health benefits, according to the same survey.

Others (4%) reduced the number of full-time employees they intended to hire and 2% increased the waiting period before new employees were eligible for benefits. But 12% extended health benefits eligibility to workers who weren't eligible before.

Researchers also analyzed the Current Population Survey from 2005 to 2015 to look at a potential increase in employers seeking out part-time employment in relation to the Affordable Care Act provisions.

"Our analysis of data from the CPS in general revealed no evidence consistent with the thesis that the ACA caused an overall increase in part-time employment in the United States," researchers wrote in the study.

They also did not observe a substantial increase in working between 25 and 29 hours or fewer than 25 hours from 2013 to 2015. If it were indeed true that there has been an increase in part-time employees, it would be reflected in a "kink" just below the 30-hour threshold, the study said.

We rate the claim as false.

Reality Check: Cruz on premiums and deductibles

By Nicole Ridgway and Tami Luhby, CNNMoney

Cruz cited the rising cost of insurance premiums and deductibles as one of the many reasons Obamacare does not work. But the figures he used to back up his claim aren't exactly relevant when it comes to the health reform law.

"The average American family, your premiums have gone up $5,462. At the same time, the average deductible has gone up $5,000. For families that are struggling, you're getting less coverage. You're paying more for it and your deductibles are higher," said Cruz.

The average annual premium for a family with employer-sponsored coverage rose $5,462 increase between 2008 and 2016, according to the 2016 Kaiser Family Foundation/HRET Employer Health Benefits study.

Families with employer-sponsored coverage did see their deductibles rise, but not by $5,000. The average family deductible in the most common type of insurance plan rose by $800 between 2008 and 2016.

Yet these figures refer to the roughly 150 million people who are insured through their employer, not through Obamacare.

The growth of premium increases in employer plans has actually slowed after Obamacare was enacted in 2010, however part of that is due to the economic downturn.

When it comes to Obamacare, premiums have increased for families, but not nearly that much. In 2014, a family of four paid an average of $789 a month for the benchmark silver plan, according to the Health and Human Services Department. By 2017, that figure went up to $1,090. Annually, the increase was $3,612, not $5,462, as Cruz said.

Also, many families don't actually pay that much. Many lower- and moderate-income Americans receive subsidies that reduce their premiums. That family of four would only pay $405 a month, on average, if they qualified for a subsidy.

The Obama administration expected 11.4 million people to be enrolled in Obamacare in 2017.

Since Cruz was referring to employer-sponsored coverage, not Obamacare, we rate this claim as false.

The section on premiums has been updated to include annual premium change.

View on CNN 

Summarized by Maven Stark



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Trump issues executive order scaling back parts of Obamacare

President Trump spent the evening of his first day in office ordering all federal departments and agencies to find ways to ease the economic burden of President Obama's health care plan as Congress works to repeal and replace it. Vice President Pence swore in Defense Secretary James Mattis and Homeland Security Secretary John Kelly, and Chief of Staff Reince Priebus ordered government agencies to freeze any regulations that haven't already been published. "Thank you, it's a great day," Trump said after the signings in the Oval Office, before leaving for a set of inaugural balls. The first-day executive actions served to signal a marked departure from the policies of the Obama administration but provided little indication of the direction Trump would chart. The executive order, titled "Minimizing The Economic Burden Of The Patient Protection And Affordable Care Act Pending Repeal," directed the administration to show maximum flexibility in applying the law to states, hospitals, health insurers, patients and, notably, medical device manufacturers. But the order was couched in language like "to the maximum extent permitted by law," leaving the particulars to legal interpretation. The regulatory freeze memo was almost word-for-word identical to a similar memo sent by President Barack Obama's chief of staff on the first day of his presidency. And that one, in turn, was based on previous memos by Presidents George W. Bush, Ronald Reagan and Jimmy Carter. It ordered all agencies to hold off on publishing any regulation until Trump's Cabinet members are confirmed and can sign off on them. The White House may make exceptions for "health, safety, financial, or national security matters." Trump made no specific policy proposals during his inaugural address. So for most of the day, something as basic as the content of the White House website became an important signal to interest groups about what issues would take priority in the Trump administration. Shortly after Trump took the oath of office, the government switched over the White House website from Obama’s to Trump’s. (Obama’s is now frozen in time, archived by the National Archives and Records Administration under the Presidential Records Act.) The Twitter accounts @POTUS and @FLOTUS now belong to Trump and first lady Melania Trump, although the Obamas seem to have taken all of their followers to @POTUS44 and @FLOTUS44. Policy proposals on Trump's revamped website ranged from increased cyber warfare capabilities to changing the terms of trade deals with other nations, issues the New York businessman discussed on the campaign trail. Also notable: There are pages on the website for the release of White House visitor’s logs, ethics pledge waivers, financial disclosures and staff salaries, suggesting that some Obama-era transparency initiatives may remain in place. And the White House “We the People” petition site also apparently survived the transition, with the first petition a plea for Trump to release his tax returns. Trump's staff posted a variety of proposals ranging from an "American First Foreign Policy" to killing Obama's climate action plan — plans largely echoing his campaign website. "For too long, we’ve been held back by burdensome regulations on our energy industry. President Trump is committed to eliminating harmful and unnecessary policies such as the Climate Action Plan and the Waters of the U.S. rule," reads the top issue brief on the new president's White House website. While the top issues on the Obama website were “Civil Rights,” “Climate Change,” “Economy” and “Education,” Trump’s site features different issues with more Trump-themed names: “America First Energy Plan,” “America First Foreign Policy,” “Bringing Back Jobs and Growth” and “Making Our Military Strong Again.” Various organizations expressed concern that, in wiping the Obama White House website nearly clean, the Trump team eliminated sections devoted to such issues as climate change, gay rights and civil rights in general. "The Department of Labor’s crucial report on worker rights has also disappeared,” said Chad Griffin, president of the Human Rights Campaign. “If President Trump truly believes in uniting the country, now is the time to make clear whether he will be an ally to the LGBTQ community in our struggle for full equality."
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Trump vows insurance for everyone while killing Obamacare

President-elect Donald Trump aims to replace Obamacare with a plan that would envisage "insurance for everybody," he said in an interview with the Washington Post published on Sunday night. Trump did not give the newspaper specifics about his proposals to replace Democratic President Barack Obama's signature health insurance law, but said the plan was nearly finished and he was ready to unveil it alongside the leaders of the Republican-controlled Congress. The Republican president-elect takes office on Friday. "It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon," Trump told the Post, adding he was waiting for his nominee for health and human services secretary, Tom Price, to be confirmed. The plan, he said, would include "lower numbers, much lower deductibles," without elaborating. “We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” Trump was also quoted as saying in the interview that he would target pharmaceutical companies over drug pricing and insist they negotiate directly with the Medicare and Medicaid government health plans for the elderly and poor. U.S. House Republicans won passage on Friday of a measure starting the process of dismantling the Affordable Care Act, popularly known as Obamacare, despite concerns about not having a ready replacement and the potential financial cost of repealing the law. With the vote, Republicans began delivering on their promise to end Obamacare, also a campaign pledge of Trump, who has called the program a "disaster." The law, which expanded health coverage to some 20 million people, has been plagued by increases in insurance premiums and deductibles and by some large insurers leaving the system. Republicans have called Obamacare federal government overreach and have sought to undermine it in Congress and the courts since it was passed by Democratic majorities in the House and Senate in 2010. Democrats say Obamacare has allowed growing numbers of Americans to get medical insurance and helped slow the rise in healthcare spending.


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Republicans move to spend billions on Obamacare — before they kill it

Most concede they can't 'pull the rug out' from people until they replace it.

On their way to killing Obamacare, Republicans are leaning toward funding up to $9 billion in health care subsidies this year to keep the program afloat. 

The move is the most significant sign yet that the GOP is serious about propping up Obamacare temporarily to provide a smooth transition to a yet-to-be disclosed Republican replacement.

This particular subsidy, which covers out-of-pocket health care costs for low-income participants, has been a GOP target since 2014 when House Republicans went to court to argue the White House funded it unconstitutionally.

Republicans were exultant last May when the Federal District Court for the District of Columbia ruled in their favor, even though the payments were allowed to continue pending an appeal.

Now, though, several Republican sources say they will have no choice but to appropriate the money. With President-elect Donald Trump and top lawmakers vowing a smooth transition to a new plan, they can't blow up Obamacare until they enact a replacement.

Energy and Commerce Chairman Greg Walden (R-Ore.) wants to see the program funded “one way or another," he told POLITICO. “If you don’t, the plans have the ability to cancel midyear, and we said we wouldn’t pull the rug out from under people — and we shouldn’t.”

The court case centers on cost-sharing subsidies that help certain low income people with out-of-pocket medical costs, such as doctors' co-pays — not the separate premium subsidies that are helping millions of people, including some middle-class families, purchase insurance through Obamacare.

If Republicans were to stop the payments, they would risk owning the very sudden and likely collapse of the Obamacare exchange markets. That’s because insurers would still be on the hook for the payments under the law, and would likely flee the markets almost immediately to avoid paying out billions.

Cutting off the money mid-year, “would be disastrous” for the state’s insurance market and those covered by it, Utah Gov. Gary Herbert wrote House Majority Leader Kevin McCarthy (R-Calif.) on Friday, urging Congress to fund the subsidies until year's end.

“As we work to re-craft healthcare in our country, we must be careful not to increase the rate of uninsured, particularly for our most vulnerable citizens,” Herbert wrote.

If Republicans do support the program, however, some fear they would be blamed for “bailing out” insurance companies. One idea that has been floated to counter that narrative is to give the funding directly to consumers rather than to insurance companies.

“What they say is, we’re only doing this because they can’t change the law quickly enough,” said Tom Miller, a health care policy expert at the American Enterprise Institute.

Several Republican sources stressed that no final decisions have been made, but they will have to come soon: The court allowed the subsidies to continue while the Obama administration appealed the decision. The Trump administration must inform the Court of Appeals for the D.C. Circuit by Feb. 21 whether it will continue that appeal. If it should stand down, the payments could end almost immediately and Congress would have to be prepared to make a decision.

Republican conversations around how to deal with the fallout of the House v. Burwell lawsuit include how the subsidy program would be funded — whether in an appropriations bill or in one of the Obamacare repeal and replacement bills— and whether the entirety of the $9 billion program would be replaced.

“While we build replacements, we want the 11 million Americans who now buy insurance on the exchanges to be able to continue to buy private insurance,” Lamar Alexander (R-Tenn.) said on the Senate floor. “Among the actions that will help are to… approve the temporary continuation of cost-sharing subsidies for deductibles and co-pays.”

Not everyone is on board with the argument that Republicans should continue the subsidy through an appropriation. 

Rep. Tom Cole (R-Okla.), chairman of the House Labor and Health and Human Services appropriations subcommittee, said the GOP isn’t responsible for funding the mistakes Democrats made while writing Obamacare.

“You can’t [fund the program] unless you’re going to increase the allocation to the committee,” he told POLITICO, referring to the overall limits on health spending his committee must work with. If the House has to fund the program, other health care programs would have to be cut to pay for it.

“I don’t know that we're particularly obligated to pay for the mistakes that the Obama administration made that violated the law,” he said.

But even Cole said he wants to see a smooth transition and doesn’t want to see benefits dropped suddenly.

Insurance companies have a huge stake in the program. The cost-sharing payments are made to insurers, who must use them to defray consumers' out-of-pocket costs. The companies added language to their contracts for 2017 that allows them to leave the market is the payments are ended, although they have not said that they would definitely drop coverage immediately.

Besides its strategy on Obamacare, the House has long-term constitutional concerns in the case.

For the first time, a federal district court said the legislature could sue the White House over appropriations disputes. The House wants to ensure that ruling stands, according to senior Republican aides. They’re likely to lose on that point if the Trump administration moves ahead with the Obama administration’s appeal, according to court-watchers.

“The D.C. Circuit [Court of Appeals] consists of a majority of judges appointed by Democratic presidents,” said Nicholas Bagley, a University of Michigan Law School professor who argues the House doesn’t have the right to sue. “I think this is not a long-term winner for them.”

“We’re working through the mechanics on it because we also want to preserve the court victory,” Walden said. “Regardless of who is in power, if you get to the point where a president can spend whatever he or she wants without any check and balance from the Congress, you don’t have these branches anymore.”

The first decision will come from the new Trump administration Justice Department. While several Republican sources expect Trump’s DOJ to drop the appeal, the president-elect’s transition team has not tipped its hand. A Trump spokesman declined to comment on the case because it involves the current White House.

“Upon taking office, the Trump administration will evaluate this case and all related aspects of the Affordable Care Act,” the spokesman said.

Obamacare didn't need Bernie Sanders supporters to fail

President Barack Obama said on Friday that criticism from the left wing of his own Democratic Party helped feed into the unpopularity of Obamacare, his signature healthcare reform law.

Obama has been spending part of his last two weeks in office urging supporters to speak out against plans by Republicans - who will soon control both the White House and Congress - to dismantle the 2010 Affordable Care Act.

At a town hall event with Vox Media, Obama acknowledged the politics have been stacked against his reforms, mainly blaming Republicans who he said refused to help make legislative fixes to Obamacare, which provides subsidies for private insurance to lower-income Americans who do not have healthcare plans at work.

But Obama also said Liberals like former Democratic presidential candidate Senator Bernie Sanders had contributed to the program's unpopularity.

During Sanders' campaign for the presidential nomination, he proposed replacing Obamacare with a government-run single-payer health insurance system based on Medicare, the government plan for elderly and disabled Americans.

"In the 'dissatisfied' column are a whole bunch of Bernie Sanders supporters who wanted a single-payer plan," Obama said in the interview.

"The problem is not that they think Obamacare is a failure. The problem is that they don't think it went far enough and that it left too many people still uncovered," Obama said.

Michael Briggs, a spokesman for Sanders, agreed that many people would rather the government "take on the private insurance industry and the pharmaceutical companies" and play a bigger role in providing healthcare.

"There are many millions of Americans, including many of Bernie's supporters, who don’t understand why we are the only major country on earth that does not provide healthcare as a right and they don’t understand why we pay more but get less for what we spend on healthcare," Briggs said.

Polling by the Kaiser Family Foundation last month showed 46 percent of Americans have an unfavorable opinion of Obamacare, while 43 percent have a favorable view. Americans are also split on whether the law should be repealed.

Trump and congressional Republicans have vowed to quickly repeal the law, but Obama and Democrats have argued they should reveal a replacement plan before dismantling the program.

More than 20 million, (although this number remains a crapshoot), previously
uninsured Americans gained health coverage through Obamacare, according to the White House. Coverage was extended by expanding the Medicaid program for the poor and through online exchanges where consumers can receive income-based subsidies.