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The Supreme Court’s ruling Monday to uphold Obamacare has created one of the biggest challenges to the GOP’s signature domestic policy achievement in years.


Lawmakers, lobbyists, even some in the Republican Party itself are now gearing up to defend the law that President Obama pledged to fully implement.

But with the GOP now holding 52 seats in the Senate and 52 seats in the House, many lawmakers and advocacy groups are trying to figure out which aspects of Obamacare — including some of the insurance expansion’s most controversial provisions — really need to die — and how.

“I think in all these discussions, there will be lots of people on both sides of the aisle who will say, ‘Well the government has control over [health insurance], it doesn’t have control the market,’ or, ‘Well the government has control over premiums,'” said Chris Jacobs of Avalere Health, an industry trade group.

Those who think the law needs to go are likely to point out that government regulations already drive the insurance prices in many places, such as in high-risk pools.

“Government regulation of the health insurance market is critical,” said Gary Claxton, president of the National Association of Insurance Commissioners. “Government regulation is the key to the stability and safety of the market on which all of these private policies and many others are based.”

In 2010, the Obama administration enacted the requirement that insurers accept everyone regardless of their health. This was dubbed the individual mandate by supporters of the law, saying the law’s core purpose is to offer insurance to everyone.

Under the individual mandate, insurance companies are required to cover a set share of all people eligible to buy insurance, regardless of health status — which has led to a huge growth in the number of people covered through the insurance marketplaces.

Many critics say the mandate will lead to higher premiums and insurance companies leaving markets — potentially costing $30 billion to $400 billion in 2017 just to insurers to keep them in the marketplaces.

But Obamacare defenders say they won’t necessarily have to leave the marketplaces.

“Insurers love [the new law], and they’re very, very happy,” said Brian Blase, chief executive at Blue Cross Blue Shield. “We certainly will still be here in 2018 and 2019.”


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