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Budget and Policy Priorities.

From President Obama’s inauguration in January 2009 until the November 2010 elections, both houses of Congress and the presidency were controlled by the Democratic Party. During the 2012 presidential election, Republican nominee Mitt Romney, running against Obama, promised to repeal the ACA, despite its similarity to Romneycare.[42] After Romney’s defeat, the ACA remained in effect for the duration of Obama’s presidency despite Republican efforts to repeal it. In the 114th Congress, Republicans passed a bill that would have repealed much of the ACA, but the bill was vetoed by President Obama.[43] After winning the 2016 presidential election, President Donald Trump promised to “repeal and replace” the ACA with a new law.[44] The 2016 elections left Republicans in control of the executive and legislative branches of the U.S. government, but with fifty-two seats in the one-hundred member Senate, Republicans would still have to rely on at least some Senate Democrats to overcome a filibuster.[45] However, Senate rules provide for a special budget rule called reconciliation, which allows certain budget-related bills to bypass the filibuster and be enacted with a simple majority vote.[45] Republican leaders were seeking to pass the AHCA through the Senate by using the reconciliation rule.[45][46]

U.S. healthcare costs were approximately $3.2 trillion or nearly $10,000 per person on average in 2015. Major categories of expense include hospital care (32%), physician and clinical services (20%), and prescription drugs (10%).[47] U.S. costs in 2016 were substantially higher than other OECD countries, at 17.2% GDP versus 12.4% GDP for the next most expensive country (Switzerland).[48] For scale, a 5% GDP difference represents about $1 trillion or $3,000 per person. Some of the many reasons cited for the cost differential with other countries include: Higher administrative costs of a private system with multiple payment processes; higher costs for the same products and services; more expensive volume/mix of services with higher usage of more expensive specialists; aggressive treatment of very sick elderly versus palliative care; less use of government intervention in pricing; and higher income levels driving greater demand for healthcare.[49][50][51] Healthcare costs are a fundamental driver of health insurance costs, which leads to coverage affordability challenges for millions of families. There is ongoing debate whether the current law (ACA/Obamacare) and the Republican alternatives (AHCA and BCRA) do enough to address the cost challenge.[52]