Pablo Martinez reporting for the Associated Press noted that President Obama met with Democrats on Capitol Hill last week, looking for ways to preserve his signature health care law in the face of stiff Republican opposition.

Senate Republicans have already taken the first step toward repealing Obamacare. On Tuesday, they introduced a budget resolution that would ultimately allow Republicans to unravel large parts of the Affordable Care Act with a simple majority vote.

Democrats still hope to defend the law, which has extended health insurance to some 20 million Americans. Repealing the law would very likely strip protection from many of those people. So far, Republicans have not reached agreement on how to replace Obamacare. And the outgoing administration mocks the idea of repeal now and replace later. “That ultimately is nothing more than just bait and switch,” said White House spokesman Josh Earnest.

The American Medical Association issued a similar note of caution in an open letter to lawmakers. The association, which supported the Affordable Care Act when it passed seven years ago, acknowledged that the law is imperfect, but said any effort to cut costs or increase choice should at least preserve the existing level of coverage.

“Before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies,” wrote the association’s CEO, James L. Madara. “Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform.”

Remember, this is what I have been harping about for many months and yes, years as the GOP threaten to repeal the ACA.

Reconciliation is a procedural tactic that would allow Senate Republicans to unwind large parts of the Affordable Care Act without the threat of a Democratic filibuster. Some Republican senators are wary of stripping health insurance from people without a plan to take its place. And conservative health care scholars Joseph Antos and James Capretta of the American Enterprise Institute warn that repeal without simultaneous replacement “carries too much risk of unnecessary disruption to the existing insurance arrangements upon which many people are now relying to finance their health services.”

Republican House Speaker Paul Ryan is undeterred, calling the budget resolution “the first step towards relief for Americans struggling under Obamacare.” In a statement, Ryan said his goal is “to ensure that patients will be in control of their health care and have greater access to quality, affordable coverage.”

President-elect Donald Trump weighed in via Twitter, writing, “People must remember that ObamaCare just doesn’t work, and it is not affordable.”

People must remember that ObamaCare just doesn’t work, and it is not affordable – 116% increases (Arizona). Bill Clinton called it “CRAZY”

He pointed to a 116 percent increase in premiums for people buying insurance on the government-run exchange in Arizona this year. Premium increases for exchange customers nationwide averaged 25 percent. Most customers shopping on the exchanges receive a government subsidy that helps to defray some or all of the increase.

Even with the higher prices and uncertainty surrounding Obamacare, the administration says customers have been signing up for coverage on the exchanges at a record pace. Why not, when you have the government and then tax payers footing the bill. But how much will the taxpayers and those with private insurance tolerate increasing premiums and deductibles tolerate the escalating costs?

Lawmakers returned to Washington and wasted no time getting to work on the repeal of Obamacare.

Sen. Mike Enzi, R-Wyo., introduced a resolution just hours after the new Congress convened Tuesday that will serve as the vehicle for repealing much of the president’s signature health care law.

“Today, we take the first steps to repair the nation’s broken health care system, removing Washington from the equation and putting control back where it belongs: with patients, their families, and their doctors,” Enzi, chairman of the Senate Budget Committee, said in a press release on his website Tuesday.

It’s the first step in Republican lawmakers’ plan to fulfill their most ardent campaign promise — to repeal the Affordable Care Act and replace it with a Republican alternative. But what is the alternative? I recently pointed out in another post the Tom Price has a bill already penned and we and a well educated health care committee should have the opportunity to critique this bill and make sure that it will improve our health care mess instead of “making more people sick” as the Democrats have shouted on the floor of Congress.

Republicans have to use a special legislative maneuver, called a budget resolution, to undo the ACA because they don’t have enough votes to overcome a Democratic filibuster in the Senate. Budget bills aren’t subject to filibuster, so lawmakers will be able to repeal the parts of the law that have budget and tax implications. That means they can essentially gut the law, removing all the subsidies that help low- and middle-income people buy health insurance and getting rid of the smorgasbord of taxes — on medical devices, insurance companies and wealthy individuals — that pay for those subsidies Enzi’s resolution calls on the Senate to get a bill to the Budget Committee by Jan. 27.

Republican lawmakers say they don’t want the 20 million people who have newly gained insurance because of the ACA to lose their coverage. So they plan to phase out Obamacare over time while they devise a replacement plan that they say will make affordable health insurance available to everyone, without the much-hated mandate to buy insurance if you don’t want it.

Many analysts are skeptical that this “repeal and delay” strategy will work.

“The most likely end result of ‘repeal and delay’ would be less secure insurance for many Americans, procrastination by political leaders who will delay taking any proactive steps as long as possible, and ultimately no discernible movement toward a real marketplace for either insurance or medical services,” said Joe Antos and James Capretta of the conservative American Enterprise Institute in a blog published Tuesday in Health Affairs.

Antos and Capretta say a partial repeal with no replacement would lead insurance companies to pull out of the Obamacare market altogether, leaving those who get coverage there today with no insurance at all.

It’s not clear exactly what will be included in the actual repeal bill. The best model we have now is a bill passed by the House and Senate and vetoed by President Obama last year. That bill eliminated the mandate for individuals to have insurance coverage right away but delayed the other parts of the repeal for two years.

“I can see how it would be hard for Republicans to maintain the individual mandate, which is possibly the most objectionable part of the ACA in their view,” says Larry Levitt, a senior vice president at the Kaiser Family Foundation. “On the other hand, getting rid of the individual mandate immediately risks a collapse of the individual insurance market.”

The ACA includes the mandate to ensure that both sick and healthy people buy insurance to spread the costs across a broad population and keep premiums low. If Republicans follow the model of last year’s bill and eliminate the mandate immediately, many healthy people would forgo insurance, and the price of coverage for sick people would spiral out of control, analysts say. “That is a prescription for health plan disaster during this transition and brings into question just how many plans would stay in the program for 2018,” says Robert Laszewski, a health policy consultant.                                                                                                                     Scott Applewhite wrote that it sounded like “Chaos versus Order” as the opening punches were thrown in what one top Democrat today called “the first big fight” of the new congressional year — the promise by President-elect Donald Trump and GOP lawmakers to repeal and replace the Affordable Care Act. President Obama met with Democrats on Capitol Hill while Vice President-elect Mike Pence sat down with Republicans, as each side prepared for the skirmishing in the days and months ahead.              Asked what advice he gave Democrats in the closed-door meeting about the legacy program that bears his name, Obama responded, “Look out for the American people.”

It was likely Obama’s last visit to the Capitol before the inauguration of his successor. White House spokesman Josh Earnest said Obama told the lawmakers he wished he were in their place. “The word he used was ‘envy,’ ” Earnest said, “for the opportunity they have” to fight GOP repeal efforts. This gut Earnest is such a pompous idiot and thank goodness we will be rid of him.

Pence told reporters that Trump will sign executive orders on his first day in office to begin implementing the repeal of Obamacare, saying it was “the first order of business.”

The incoming administration, Pence said, is working right now on “a series of executive orders that will enable that orderly transition to take place even as the Congress appropriately debates alternatives to and replacement of Obamacare.”

He did not offer any specifics on what those orders would entail. He said Republicans will be taking a “two-track approach” with a combination of executive and legislative actions. Although, I really believe that the President-Elect is smarter that that as he realizes that he needs both parties to come to grips with a workable solution.

The new leader of Senate Democrats, Chuck Schumer of New York, said GOP lawmakers seek “to rip health care away from millions” of Americans, “which will create chaos.” In his short, prepared statement, he repeated the word “chaos” four times. Schumer said Democrats in both the House and the Senate are united in their opposition to Republican attempts to “make America sick again.”

House Speaker Paul Ryan said Republicans asserted, however, that there would be “an orderly transition, so that the rug is not pulled out from under the families,” which he said are currently “struggling” under Obamacare. But replace it with what? Ryan offered no specifics, except to insist Republicans do “have a plan to replace it. We have plenty of ideas to replace it”, remember Tom Price.

But House Democratic leader Nancy Pelosi, addressing reporters after hearing from Obama, said Republicans don’t have the votes for a replacement plan. Pelosi blasted an approach that some Republicans have discussed, that would repeal the ACA but delay its effect to give lawmakers time to come up with a replacement. She called the strategy “an act of cowardice.”

Trump himself weighed in today via his preferred method of communicating, tweeting that “Republicans must be careful in that the Dems own the failed Obamacare disaster” and “Don’t let the Schumer clowns out of this web.” He warned that “massive increases of ObamaCare will take place this year and Dems are to blame for the mess. It will fall of its own weight — be careful!”                                                                                                                     Rick Bowman attempts to fact check the issues for us stating that President Obama and Vice President-elect Mike Pence were both on Capitol Hill Wednesday, making competing cases for and against Obama’s signature health care law. Republicans have promised to make repeal of the Affordable Care Act their first order of business, once they control both Congress and the White House.                                                                                                        Obama is urging his fellow Democrats to do what they can to preserve the law. If that fails, Democrats plan to hold Republicans accountable for any disruption the repeal may trigger. Both sides are trying to position themselves as the protectors of Americans’ health care, while branding the other party as a dangerous threat.

As usual, the truth may be somewhere in between. Here Mr. Bowman takes a closer look at some of the claims being floated by both parties:

President-elect Trump got the ball rolling with a pre-dawn tweet, cautioning that “Republicans must be careful in that the Dems own the failed ObamaCare disaster, with its poor coverage and massive premium increases……” Republicans must be careful in that the Dems own the failed ObamaCare disaster, with its poor coverage and massive premium increases……

Republican House Speaker Paul Ryan echoed Trump. “This law has failed,” Ryan told reporters. “We know that things are only getting worse under Obamacare. This is about people paying higher premiums every year and feeling powerless to stop it. It’s about families paying deductibles that are so high it doesn’t even feel like you have health insurance in the first place. And in so many parts of the country, as you’ve always heard, even if you want to look for better coverage, you’re stuck with one option. One choice is not a choice. It is a monopoly. The health care system has been ruined, dismantled under Obamacare.” Is there any truth in these allegations??

CLAIM: Obamacare suffers from “massive premium increases”

FACT CHECK: True in some cases, but it’s also relative. Obamacare is also actually cheaper on average than the typical employer-provided plan.

Many people shopping for health insurance on the government-run exchanges set up by Obamacare have seen double-digit premium increases this year. The average cost of a benchmark plan rose 25 percent nationwide, but there was considerable variation from state to state. As I previously stated premiums in Arizona jumped an average of 116 percent, while premiums in Indiana and Massachusetts actually went down. Most people buying insurance on the exchanges receive a government subsidy, which helps defray the cost.

A study by the Urban Institute last year found that even without the subsidy, insurance policies sold on the exchanges cost about 10 percent less than the typical employer-provided plan. Exchange policies might seem more expensive, because part of the cost of workplace plans is typically paid by employers, and thus largely invisible to the employee.

CLAIM: “You’re stuck with one option” under Obamacare

FACT CHECK: Not true for the majority, but it has increasingly become the case.

Obamacare insurance exchanges have grown less competitive, as some insurance companies have lost money and left the market. One in five customers on the exchanges had just one insurance company to choose from this year (up from 2 percent in 2016). Nearly 6 in 10 customers have a choice of three or more companies. The lack of competition, which can lead to higher prices, tends to be worse in rural areas and the South.

Insurance companies have struggled, in part, because fewer young, healthy people have signed up for coverage than forecast. Backers of the Affordable Care Act say that could be remedied with more generous subsidies to encourage sign-ups or bigger penalties for those who fail to enroll. Obama also renewed the idea of a public insurance option to supplement private offerings.

CLAIM: “The health care system has been ruined, dismantled under Obamacare”

FACT CHECK: Prices were going up at faster rates before Obamacare.

Most Americans under age 65 still get health insurance through an employer, although the percentage has been slowly dropping. The cost of employer-provided coverage has gone up since passage of the ACA. But the annual price hikes were considerably larger in the decade before the law was passed. Some of the savings from slower premium growth have been offset by higher deductibles.

While Republicans highlight the shortcomings of the Affordable Care Act, Democrats warn that repeal would be much worse.

“Instead of working to further ensure affordable care for all Americans, [Republicans] seek to rip health care away from millions of Americans, creating chaos in our entire economy,” Democratic Senate leader Chuck Schumer said Wednesday. He and his fellow Democrats offered a mocking slogan for the GOP: “Make America Sick Again.”

Schumer also suggested that repealing Obamacare would hurt rural hospitals, “right in their heartlands. The minute they enact this repeal, [hospitals] are going to suffer dramatically,” he said.

CLAIM: ACA repeal would “rip health care away from millions”

FACT CHECK: True, if Republicans don’t protect them or replace ACA with something that provides coverage.

The Affordable Care Act has expanded health care coverage to some 20 million Americans through a combination of subsidized individual policies, expanded Medicaid, and allowing young adults to stay on their parents’ plans. The uninsured rate has fallen to an all-time low of around 10 percent. Coverage would be higher still if 19 states had not refused to expand Medicaid.

If the Republican-controlled Congress repeals the Affordable Care Act, many of those newly insured Americans would be at risk of losing coverage. In addition, millions more who buy individual insurance policies off the exchanges could be at risk, if that market is disrupted. The Urban Institute estimates as many as 30 million people in all could lose their health care coverage, doubling the uninsured rate.

Republicans have promised an orderly transition as they work toward a replacement for Obamacare, and it’s possible the effective date for any repeal could be delayed for a number of years. Insurance companies, however, may be reluctant to participate once it’s clear Obamacare’s individual market is being phased out.

CLAIM: Rural hospitals are going to suffer

FACT CHECK: True, if repealed outright, but it’s also because of the way the ACA was structured in the first place.

The concern for hospitals reflects a trade-off when the ACA was passed seven years ago. The government scaled back what it pays hospitals for treating Medicare patients and the indigent, with the expectation that would be offset by payments from millions of newly insured.

Hospitals worry that if repeal of the law cuts insurance coverage, but doesn’t restore other payments, they could be left with a mountain of unpaid bills. The American Hospital Association and the Federation of American Hospitals urged Congress and the incoming Trump administration to either protect insurance coverage or replace the hospital payments.                                                                                                                   So, what is the answer? Modify not repeal the ACA. Because if the GOP doesn’t improve the health care system, as in the Pottery Barn, you broke it, you own it and the 2018 election will be ugly, with the GOP losing their majority in both houses!!