GOP senators were blindsided by Trump on ObamaCare this week. This past week as President Trump was feeling good and relieved about the Mueller report so what does he do? He starts the promise to throw out Obamacare! And what does that do to all the Republicans trying to support him and about to campaign for another term? Confusion?

Republican lawmakers were caught completely off guard by President Trump’s renewed push to repeal and replace ObamaCare and privately complain it’s a dumb political strategy heading into the 2020 election. Senate Finance Committee Chairman Chuck Grassley (R-Iowa), whose panel has jurisdiction over health care, said he received no heads-up from Trump or the White House that the president would call Tuesday for the GOP to become “the party of health care.”

“I don’t think there was any heads-up on anything that he was going to say,” said Grassley, who added that he didn’t even know Trump was meeting with the GOP conference on Tuesday until Monday night.

Sen. Lamar Alexander (R-Tenn.), the chairman of another key panel that handles health care, said he didn’t know about Trump’s new health care push until the president tweeted about it at 11:58 a.m. Tuesday, shortly before he walked into a Republican conference lunch to announce it in person.

If Trump had told GOP senators of his plans, they say they would have sought to convince him not to throw their party back into a war over health care — the issue Democrats believe was instrumental to their takeover of the House in last year’s midterms.

A safe 2018 Senate map that had Republican incumbents defending just a handful of seats and Democrats trying to protect senators in deep-red states helped the GOP overcome the blue wave in the House. Republicans actually gained two seats in the Senate.

But the 2020 map is seen as more challenging, and many in the GOP can’t understand why Trump would plunge them into a fight over health care just as he was surfing a wave of good news brought by the end of special counsel Robert Mueller’s investigation.

“It doesn’t seem to make sense politically,” said one Republican senator, who questioned why Trump would give Democrats a new avenue of attack.

Another Republican senator said, “We would be crazy to try to go through what we went through again,” referring to the failed 2017 effort to repeal ObamaCare, which fell one vote short in the Senate.

A third Republican senator expressed hope that Senate Majority Leader Mitch McConnell (R-Ky.) will join House Minority Leader Kevin McCarthy (R-Calif.) in pressing Trump to back off his aggressive push to defeat the 2010 health care law in court.

“I would think McConnell and crew would be using their influence to get the administration to stop this,” the source said.

The lawmaker said Trump is “throwing down a challenge in advance of the elections which makes it even more difficult,” describing the current politic environment as “toxic” for passing ambitious legislation.

“If you look at past history, we don’t really know how to do it,” the senator added, referring to broad health care legislation.

McCarthy urged Trump in a phone call to drop his administration’s effort to have the law struck down in the courts, arguing the strategy makes little sense after Democrats won control of the House in November after campaigning on health care, according to reports Wednesday by Axios and The Washington Post.

Trump, nevertheless, doubled down on his position Wednesday. He defended the Justice Department’s argument for striking down the law he called a “disaster,” arguing that it had sent premiums soaring and has turned out to be “far too expensive for the people, not only for the country.”

“If the Supreme Court rules that ObamaCare is out, we’ll have a plan that is far better than ObamaCare,” the president promised at the White House on Wednesday.

Trump told Republican senators at the Tuesday meeting that he wants GOP lawmakers to come up with a health care package to replace the Affordable Care Act (ACA) if the courts strike down former President Obama’s signature law.

Sen. Susan Collins (R-Maine), who is up for reelection in a state Democrat Hillary Clinton carried in 2016, said Trump’s bold promise that Republicans will have a plan to replace ObamaCare if it’s struck down by the Supreme Court has “got the cart before the horse.”

She said, “There are some very important, good provisions of the ACA that have helped to expand health insurance for low-income Americans” and also “provide important consumer protections to virtually all of us, and I would not want to see those abandoned.”

“For the administration to advocate for invalidating a duly enacted law is a mistake, in my view,” she added.

Sen. Cory Gardner (R-Colo.), who is also up for reelection in a state that voted for Clinton in 2016, declined to comment on whether he agrees with the administrative support for striking down protections for people with pre-existing conditions and other ACA reforms.

Senate Majority Whip John Thune (R-S.D.) warned that the issue of health care reform hasn’t worked for Republicans in the past.  “It’s historically probably not been a great issue for Republicans,” he said.

Thune did say the GOP could turn it around “if we’re providing solutions that create lower premiums and copays and deductibles for people.”

Alexander said he had not planned to grapple with the thorny problem of insurance reform this Congress and instead wanted to focus on finding ways to lower health care costs by looking at prescription drug costs, surprise billing and the 340B drug pricing program.

Grassley said he had planned to work primarily on prescription drug costs — not finding a new plan to replace ObamaCare.

McConnell has counseled colleagues that it is smarter to play offense by attacking Democrats for their most liberal proposals, such as providing Medicare for all, instead of playing defense on the GOP’s own plan, said a Republican senator familiar with McConnell’s advice on the subject.

Republican senators say the onus should be on Trump to come up with a health care plan since it’s his idea.

“I’d like to see what the administration brings forward. The first step is to see what the president and the White House have with regard to their health care plan and be able to respond to that,” said Sen. Mitt Romney (R-Utah).

Sen. Joni Ernst (R-Iowa), who is up for reelection next year, agreed that it would be “reasonable” for the White House to take the lead on health care reform.

“What we don’t want to do is start working in 50 different directions this Congress and not have it supported by the administration,” she said.

Republicans face an uphill battle in their bid to fulfill President Trump’s prophecy that the GOP will become “the party of health care.”

The presidential directive, handed down in a tweet on Tuesday, came at an inopportune time for Republicans, less than a day after the Trump administration called for the courts to invalidate the Affordable Care Act (ACA) in its entirety.

Taken together, that announcement and Trump’s ambitious call to resurface a campaign promise that has eluded Republicans for years underscores the political peril facing the GOP in 2020, as well as the long road the party faces if it hopes to, in fact, become “the party of health care.”

“People already believe that Republicans have the wrong approach to health care,” Doug Thornell, a longtime Democratic strategist, and adviser, said. “When the White House makes the kind of announcement it just did, it reinforces that.”

For Democrats, the GOP’s posture on health care has already proven to be one of their most incisive lines of attack, helping them win 40 House seats in the 2018 midterm elections.

With 2020 fast approaching, Democrats are eager to revive the issue.

“I would love it if the Republicans want to make this campaign about health care,” Thornell said. “That would be fantastic. I think any Democrat would love to have that debate.”

By and large, available polling data shows Democrats with an edge in the health care debate. An NBC News/Wall Street Journal poll released earlier this month found that 56 percent of respondents see Democratic positions on health care as being “in the mainstream,” compared to only 38 percent who said the same of the Republican Party’s views on the issue.

A Harvard CAPS/Harris poll released exclusively to The Hill this week brought similarly good news for Democrats.

Fifty-eight percent of respondents in that survey said they trust the Democratic Party more to handle health care. Meanwhile, 48 percent said they trust Republicans on the matter.

The polls are reflective of a larger trend in public opinion.

Democrats have largely seen support for their handling of health care tick upwards in recent years, available polling data shows. For Republicans, the numbers have either remained stagnant or trended downwards.

Despite those trends, Republicans have sought to turn the tables in recent months as some in the Democratic Party, including several presidential hopefuls, lurch to the left on health care and embrace a single-payer, Medicare for All approach.

That approach, favored by the party’s progressive and activist base, has received mixed receptions among the broader electorate.

A Quinnipiac University poll released Tuesday found 45 percent of Americans opposing Medicare for All and 43 percent backing the proposal.

“That’s the rhetoric that really scares a lot of voters – I would think a lot of independent voters, a lot of suburban voters, voters that Dems did really well with last time,” Doug Heye, a Republican strategist, said.

While Republicans had hoped to seize on public unease with such sweeping reforms, Heye said that the Trump administration’s legal shift on the ACA could complicate that effort by putting the onus on Republicans to stake out their own position on health care.

“It’s why the announcement from the White House was surprising,” said Heye, who also served as an aide to former House Majority Leader Eric Cantor (R-Va.). “If your opponent is running off a cliff, it’s best to stay out of their way.”

It also forces the party to wrestle with a frustrating reality for many of its members: After multiple failed attempts to repeal the ACA, Republicans are still largely divided on exactly how to replace former President Obama’s signature health care law, which has seen its favorability tick upwards in recent years.

A Quinnipiac University poll released Tuesday found that 55 percent of Americans support improving the country’s current health care system, rather than replacing it entirely.

If Republicans ultimately decide to take another crack at replacing the ACA, it’s unclear where such a plan will originate.

Marc Short, a former White House aide who is now Vice President Pence’s chief of staff, said on CNN Wednesday that Trump will submit a plan to Congress sometime “this year.”

But Rep. Mark Meadows (R-N.C.), the chair of the ultra-conservative House Freedom Caucus, said on Thursday that any plan to replace the ACA would be in collaboration with congressional Republicans.

“It’s my impression there will be a plan the president and White House endorses, but I think it will be a collaborative effort between House and Senate Republicans,” Meadows said.

Heye said that if Trump wants to define the Republican Party with a robust health care agenda, it would have to be the White House —rather than GOP lawmakers — that takes the lead.

“We were never able to agree on a white paper — and that’s when we had the [House] majority,” Heye said. “If we weren’t able to do that on our own, the only way that this gets done is if the White House goes all in and long term.”

“Is the White House prepared to do that? We haven’t really seen a whole lot of other examples of where they have.”

It brings up one of last week’s suggestion for repairing the Affordable Care Act, which applies to whatever we design for a health care system-Listen to the Doctors. Doctor’s Orders: Don’t Repeal Obamacare/Affordable Healthcare Act Until You Have A Plan To Replace It!

Jonathan Cohn noted that a major physicians group is also asking GOP leadership to preserve the law’s historic coverage gains. The largest and most influential organization of American physicians has sent two stark messages to the Republican Party: Don’t mess with Obamacare until you know what you’re putting in its place.

And don’t do anything that would backtrack on the law’s most important accomplishment ― bringing the number of uninsured Americans to a historic low.

The American Medical Association delivered these messages on Tuesday, in an open letter addressed to congressional leaders of both parties. But its intended audience was GOP leadership and members President-elect Donald Trump’s incoming administration who have said repealing the Affordable Care Act would be their first order of business.

Two days into the new congressional session, GOP leaders have already started the legislative process that would eventually allow them to kill Obamacare, by stripping out it’s funding and spending with simple majority votes in both houses.

Vice President-elect Mike Pence met with GOP leaders, including House Speaker Paul Ryan, on Wednesday to discuss strategy and rally rank-and-file members.

But Republicans have promised for nearly seven years that they could replace Obamacare with something better, and even party leaders acknowledge that they have no consensus on how to do that.

In the letter, AMA CEO and vice president James Madara warned Republicans not to repeal the law until they could “layout for the American people, in reasonable detail, what will replace current policies.”

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. AMA CEO James Madara announced that with its warning against a hasty repeal vote, the AMA joins a chorus that includes other industry groups and even some well-known conservative experts on health policy. But the AMA’s letter was striking in two key respects.

One was its explicit call for Republicans not to let the number of uninsured Americans increase again. “In considering opportunities to make coverage more affordable and accessible to all Americans, it is essential that gains in the number of Americans with health insurance coverage be maintained,” Madara wrote.

None of the serious Obamacare alternatives circulating in conservative think tanks or on Capitol Hill could meet that standard, except perhaps by offering insurance that left individuals more exposed to crippling medical bills.

The other striking element of the AMA letter was its insistence that Republicans reveal their replacement plan before repealing the law ― not simply to avoid the insurance chaos that a quick repeal vote could unleash, but also to give the public an opportunity to decide whether it actually prefers GOP-style health care to what exists now.

“We … recognize that the ACA is imperfect and there a number of issues that need to be addressed,” Madara wrote.

But, Madara went on to say, “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.”

Doctors speaking up for expansions of health insurance might sound like the ultimate dog-bites-man story. But until relatively recently, the AMA hasn’t been a big cheerleader for government-run or government-managed health care plans.

On the contrary, in two of history’s biggest fights over health care reform ― President Harry Truman’s failed effort to create national health insurance in the 1940s and President Lyndon Johnson’s successful effort to create Medicare in the 1960s ― the AMA was among the most vocal and effective opponents of new laws.

Sentiments shifted over time, however, and the AMA, like most of the health care industry, ended up supporting the ACA. But the AMA still has a conservative streak ― it issued a quick, if ultimately controversial, endorsement of Rep. Tom Price (R-Ga.), Trump’s nominee for secretary of Health and Human Services.

Price, an orthopedist, is a leader of the GOP’s conservative wing. In addition to seeking Obamacare repeal, he has called for turning Medicare into a voucher program and dramatically downsizing Medicaid. Posted by:  The Wealthy Doctor

Summary: The largest and most influential organization of American physicians has sent two stark messages to the Republican Party: Don’t mess with Obamacare until you know what you’re putting in its place. And don’t do anything that would backtrack on the law’s most important accomplishment ― bringing the number of uninsured Americans to a historic low.

Stabilize the individual marketplaces

Leslie Small noted that getting young, healthy people to purchase coverage on the ACA exchanges is a tough sell and was the reason for the rejection of the Individual Mandate by President Trump and the Republicans and for good reason.

With Republicans’ efforts to repeal and replace the Affordable Care Act all but dead, both Democrats and some GOP lawmakers have acknowledged that now is the time to try to make changes that will help shore up the law’s individual marketplaces.

The most obvious step, which healthcare industry groups, policy experts, politicians, and actuaries have all endorsed, is to continue funding cost-sharing reduction (CSR) payments. Though a recent appeals court decision allows state attorneys general to defend these subsidies’ legality, the Trump administration could still stop funding them, and insurers likely can’t count on receiving the payments as they file their rates for next year.

Congress could settle the issue by passing a bill to appropriate the funds, but that approach would likely face an uphill battle. And it may come too late to prevent major premium hikes and insurer exits next year.

Other viable steps to stabilize the individual marketplaces include:

Enforcing the individual mandate but have reasonable premiums that don’t increase by 75-125% each year, which is nonsustainable!!

As long as the ACA is the law of the land, its signature individual exchanges depend upon the “three-legged stool” comprised of the individual mandate (which requires all citizens to have health coverage or pay a fine), guaranteed issue (which bans insurers from denying coverage based on health status) and community rating (which bans insurers from charging higher premiums based on health status).

One surefire way to help stabilize the ACA exchanges is to have the IRS enforce the individual mandate. Knock out one of those legs, and the resulting adverse selection collapses the whole system, likely leading to the much-feared “death spiral.” Enforcing the individual mandate is simple: The Trump administration just has to direct the IRS to keep assessing tax penalties on the uninsured—politically unpopular as that may be.

Implementing a stabilization mechanism

The most popular option among policy experts seems to be the creation of a reinsurance program—or recreation since the ACA implemented a temporary one. It works by issuing payments to insurers that have enrollees whose costs exceed a certain level, and its market-stabilization potential is already on display in Alaska, which recently got the go-ahead from CMS to extend its reinsurance program.

A popular idea among some conservatives, meanwhile, is to create a high-risk pool for individuals with pre-existing conditions. Pre-ACA, Maine did this successfully, but the secret ingredient to its program was adequate funding—a feature that did not characterize other states’ attempts.

Encouraging more young, healthy enrollees

Just like the individual exchanges depend upon having an individual mandate, they also require younger, lower risk individuals to purchase coverage to balance out the risk pool. But getting them to actually purchase coverage is a tough sell, requiring robust outreach efforts and the availability of affordable options—the latter made even tougher by premium spikes likely to result from uncertainty over CSRs.

One idea that policy experts might endorse—but nearly everyone else would hate—would be to nix the ACA’s provision that allows young adults to stay on a parent’s plan until age 26, effectively forcing those without job-based insurance into Medicaid or the individual markets.

And now Joyce Frieden noted that what I already mentioned when I began this post, President Trump delivered a rousing healthcare message to his followers at a Thursday night rally in Grand Rapids, Michigan, capping off a week of other presidential actions on healthcare.

“We’re going to get rid of Obamacare,” the president told the cheering crowd. “And I said it the other day, the Republican Party will become the party of great healthcare. It’s good; it’s important.”

Trump was referring to comments he made Tuesday to reporters shortly before a meeting with Senate Republicans. A reporter asked him what his message was to Americans concerned about their healthcare. “Let me tell you exactly what my message is: The Republican Party will soon be known as the ‘Party of Healthcare,'” he said. “You watch.”

Justice Dept. Files Letter in ACA Case

The reporter asked the question in the wake of a letter filed Monday by the Justice Department relating to a lawsuit by a group of Republican attorneys seeking to overturn the entire Affordable Care Act (ACA). A federal district court judge in Texas sided with the attorneys, declaring that because Congress had reduced the fine to zero, people were required to pay if they didn’t have health insurance — a provision is known as the “individual mandate” — and the rest of the law was now invalid.

That decision was appealed to the Fifth Circuit Court of Appeals in New Orleans, which is now considering the case. In its letter, the Justice Department said it “has determined that the district court’s judgment should be affirmed.” This was a change from the department’s earlier position, which was that only certain provisions of the law — including the individual mandate, the provision requiring insurers to cover preexisting conditions, and the provision requiring insurers to issue policies to anyone who applies for them — should be struck down. Whatever the appeals court decides, the case is widely expected to make its way to the Supreme Court.

“We won the case; now it has to be appealed, and then we’ll go to the United States Supreme Court. We have a chance of killing Obamacare,” Trump said at the rally. “We almost did it [in Congress], but somebody, unfortunately, surprised us with a thumbs down, but we’ll do it a different way.” Trump was presumably referring to the late Sen. John McCain (R-Ariz.), who cast the deciding vote against a Republican effort to repeal and replace the ACA. (Two other GOP senators also voted against it.)

Again, I ask what the other doctors are asking-why try to destroy Obamacare if you all have no workable alternative?

Next week more suggestions!