In it, but not of it. TPM DC

For years Republican critiques of the Affordable Care Act have zeroed in on the effect it has had on the individual heath insurance market. But the GOP lawmaker who will likely lead the Department of Health and Human Services has long championed a major overhaul to the much bigger employer-based insurance system in order to push consumers to buy their own plans.

The legislation HHS nominee Rep. Tom Price (R-GA) has offered over the years include mainstays of GOP plans that would usher in a drastic change in how most people receive their health care coverage. The employer-based insurance market covers seven times more people than the individual market.

"What he's getting at here, and a lot of Republicans feel pretty strongly about this, to get a functioning insurance market, you have to get away from businesses buying the insurance," explained Joe Antos, a health policy scholar at the right-leaning American Enterprise Institute. "The philosophy is, ultimately, you want to transition, in some orderly way, to where everybody is buying their own insurance."

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Congressional Republicans aren’t sure what President-elect Donald Trump’s “plan” for replacing Obamacare is, but many were perfectly confident that it would fit in neatly with their effort to dismantle the Affordable Care Act, which has already been bogged down intra-party disagreements.

Key senators in the repeal effort admitted this week -- after Trump told the Washington Post that he would be unveiling a plan that would bring “insurance for everybody” --- that they had not seen details of the alleged plan. It was also unclear if they knew such a plan existed before Trump’s comments about it. Still, even though they weren’t sure exactly what Trump meant when he said “insurance for everybody," they assumed his interpretation of the ideal Obamacare replacement matched their own: that the goal would be making the cost of insurance cheaper for consumers to expand “access,” rather than universal coverage.

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Donald Trump's nominee to lead the Environmental Protection Agency, Scott Pruitt, on Wednesday would not commit to recusing himself from issues related to the lawsuits he brought against the EPA as attorney general of Oklahoma.

Sen. Ed Markey (D-MA) noted that Pruitt has brought several lawsuits against EPA regulations, and noted that Pruitt would be "plaintiff, defendant, judge, and jury" if confirmed as the EPA administrator. He asked Pruitt to commit to recusing himself to issues related to the cases he brought against the EPA.

In response, Pruitt said he would follow the guidance of the EPA's ethics office.

Markey then asked, "Are you saying you will not recuse yourself from the actual matters which you’re suing the EPA on right now as attorney general of Oklahoma for the time that you are the head of the EPA?"

"I'm not saying that at all, Senator," Pruitt replied.

"You are saying that. Will you recuse yourself?" Markey asked.

Pruitt again said he would follow the guidance of the ethics office at the EPA.

"You’re not committing, and I think that's a big mistake," Markey said in response.

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As concerns escalate over the GOP’s plans to repeal Obamacare, and what it means for the millions with pre-existing conditions whose coverage has been guaranteed by the law, Republicans have pointed to so-called high-risk pools, as if they were magic bullet of sorts for covering seriously sick individuals.

However, using high-risk pools as a substitute for the Affordable Care Act would cost a boatload of money, health care policy experts tell TPM, and when states implemented it in the past, it was often consumers who were left picking up the tab or left out of the system entirely.

“It’s better than nothing, to help some people,” said Henry Aaron, a senior fellow in the Economic Studies Program at the Brookings Institution, “but it’s a massive step backward from the Affordable Care Act.

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Earlier this week, Sen. Lamar Alexander (R-TN) did something few Republicans have dared to do since the election: go into some detail of how he would like to see lawmakers go about transitioning into a replacement for an Affordable Care Act.

His vision, which he outlined in a speech on the Senate floor Tuesday, is earning measured praise from some health care policy experts for at least acknowledging that Republicans may have to keep some aspects of Obamacare alive while they work on an alternative to avoid causing major chaos to the individual market.

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Sen. Bill Cassidy (R-LA) is having conversations with "four or five" Democrats he hopes will help him work toward a replacement for the Affordable Care Act, but he said that Democrats are still waiting to see if Republicans will get their act together before signing on.

"We have to show that we have our act together before they're going to risk it," Cassidy told reporters. "I'm okay with that."

Cassidy said he didn't know if other colleagues were trying to reach across the aisle at this point.

"I want this to be an American solution, not a Republican solution," he said. "I say that not rhetorically, but the only major social programs that have worked in our country have been bipartisan, and we need this to be bipartisan."

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