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The health law has been wounded in a year of Trump.
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Health care

The health law has been wounded in a year of Trump.


The manadate's repeal is only one of several heavy blows to the health law since President Donald Trump and the GOP swept in nearly a year ago. | Evan Vucci/AP

Obamacare survived the first year of President Donald Trump, but it’s badly damaged.

The sweeping Republican tax bill on the verge of final passage would repeal the individual mandate in 2019, potentially taking millions of people out of the health insurance market. On top of that, the Trump administration has killed some subsidies, halved the insurance enrollment period, gutted the Obamacare marketing campaign, and rolled out a regulatory red carpet for skimpy new health plans that will change the insurance landscape in ways that are harmful to former President Barack Obama’s signature health care law.

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None of these individually represent a death blow. But in aggregate, the past year adds up to a slow, stealthy erosion of the law.

“They obviously couldn't kill it, so they're trying to starve it slowly," said Rep. Bill Pascrell (D-N.J.), who sits on the House Ways and Means Committee, which helped write the original law.

Advocates acknowledge that Obamacare is weakened, but they also take heart that it has so far survived the onslaught, though in a stripped-down form. In fact, one poll after another has found that the health law is increasingly popular with the American public. Some insurers are finding their footing in the Obamacare markets — although whether the health plans ride out the ongoing turmoil or make a run for the exits will help determine if the law survives, and in what form.

“It’s wounded,” said Jon Kingsdale, who ran the Massachusetts health exchange, the prototype for Obamacare. Yet he and other policy experts noted that the basic framework of the Affordable Care Act — the online marketplaces, the consumer protections, the subsidies that help millions afford insurance — remain in place, as does the Medicaid expansion, which brought insurance to about 12 million newly eligible people. As long as that core survives, it can be rebuilt, Kingsdale said, should such a political moment arrive.

For the Republicans who spent a hamster-wheel of a year trying and failing to repeal and replace Obamacare, their swift dispatch of the unpopular mandate in the tax bill is a sweet and surprising victory. Americans didn’t like being told to get health coverage or pay a fine. Now, Republicans can tell them, they won’t have to.

And with the mandate out of the way, Republicans hope it will be easier to unravel even more of the ACA. If they can’t get the votes to repeal it, they can still try to force its collapse.

Get the latest on the health care fight, every weekday morning — in your inbox.

“Getting rid of the individual mandate, that’s one of the keys that opens the door for us,” said Rep. Michael Burgess (R-Texas), calling the mandate “the obstacle that prevented any rational discussion on health policy.”

Several Republican senators met Tuesday to lay out their 2018 strategy for picking up repeal efforts where they left off.

"I think we're all going to say that we ripped the heart out of Obamacare with the individual mandate," said Sen. Lindsey Graham (R-S.C.), who with Sen. Bill Cassidy (R-La.) has pushed to dismantle Obamacare and turn it over to the states. "It's pretty hard to rip the heart out of it and not replace it."

"Once you've repealed individual mandate," Graham added, "politically, you own this thing."


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