Tag Archives: Healthcare

Trump backs House healthcare plan, says open to negotiations

The federal government forms for applying for health coverage are seen at a rally held by supporters of the Affordable Care Act, widely referred to as "Obamacare", outside the Jackson-Hinds Comprehensive Health Center in Jackson, Mississippi, U.S. on October 4, 2013. REUTERS/Jonathan Bachman/File Photo

WASHINGTON (Reuters) – U.S. President Donald Trump on Tuesday backed a draft Republican proposal to dismantle Obamacare that was unveiled Monday, saying the proposed healthcare legislation was “out for review and negotiation.”

Trump, in a tweet on Tuesday morning, described the bill proposed by fellow Republicans in the House of Representatives as “Our wonderful new healthcare bill.”

The plan, released late on Monday, would undo Democratic President Barack Obama’s 2010 healthcare law, removing the penalty paid by Americans without insurance coverage and rolling back extra healthcare funding for the poor.

The plan was swiftly criticized by Democrats.

Although Obamacare has long been a common target of Republicans, the proposal also met with skepticism from some in the party who are concerned about the replacement plan’s tax credits for buying health insurance and changes to coverage under Medicaid, the government health insurance program for the poor.

The plan must pass both the Republican-led House of Representatives as well as the Senate, where it faces a higher bar for passage, making its future uncertain.

Trump was due to meet with the team of House lawmakers charged with tracking support for legislation later on Tuesday as lawmakers on two key House committees prepare to review the bill on Wednesday.

White House Office of Budget and Management Director Mick Mulvaney, speaking in a round of television interviews on Tuesday, said he expected the plan to pass the House before lawmakers leave for recess in mid-April.

Still, Obamacare remains popular with many Americans. Some 20 million previously uninsured Americans gained coverage under the law, although higher insurance premiums have angered some. Nearly half of those gained insurance under an expansion of Medicaid, which would end in 2020 under the Republicans’ new plan, then face funding caps.

Polls have shown most Americans want to maintain Medicaid’s expansion.

Some industry groups have also expressed concern that lawmakers are moving forward without knowing how much the new proposal will cost or how it will affect healthcare coverage. Mulvaney told CBS he expected the Congressional Budget Office’s review of the bill in a few days.

House Democratic leader Nancy Pelosi said on CBS program “This Morning” that the Republican plan would take millions of people off health insurance rolls. “Show us the numbers about what the impact is personally on people,” she said.

(Reporting by Susan Heavey and Doina Chiacu; Editing by Frances Kerry)

Patients trapped after roof collapse at Johannesburg hospital

Rescue workers are seen at a site of a roof collapse at Johannesburg's Charlotte Maxeke state hospital in Johannesburg, South Africa. REUTERS/Siphiwe Sibeko

JOHANNESBURG (Reuters) – Patients and workers were trapped after a roof collapsed at Johannesburg’s Charlotte Maxeke state hospital on Thursday, an incident that highlighted the funding shortages in South Africa’s public health system, officials said.

The roof caved at the hospital reception area as construction workers were trying to seal a leak after a heavy storm, officials said. Five people suffered minor injuries and it was not clear how many people were still trapped.

Two of the injured were patients, two were construction workers while one person was a hospital staff member.

The hospital, one of South Africa’s biggest, is nicknamed Joburg Gen and is used for academic purposes due to its proximity to the University of the Witwatersand.

“We’re not sure how many people are trapped. At the moment the rescue team is on site clearing the debris as fast and as safely as they can,” Gwen Ramokgopa, the head of the provincial health department, said at the hospital.

She said contractors “were working to seal the roof because it was leaking and the structure caved in.”

Television footage showed rescue workers trying to remove rubble and steel pipes to try and reach those trapped by the debris as heavy rain pounded the South African commercial capital.

State hospitals in South Africa have been struggling with persistent underfunding for staff, equipment and facilities.

The roof collapse comes amid public outrage at the provincial health department over the deaths of at least 94 psychiatric patients who died after being moved from a licensed home to unregistered facilities.

(Reporting by James Macharia and TJ Strydom; Editing by Ed Cropley)

Venezuela’s epileptic patients struggle with seizures amid drug shortage

Miguel Anton (C) feeds his son Jose Gregorio Anton, 11, a neurological patient being treated with anticonvulsants, at their house in La Guaira, Venezuela February 20, 2017. REUTERS/Carlos Garcia Rawlins

By Andreina Aponte

MAIQUETIA, Venezuela (Reuters) – Venezuelan plumber Marcos Heredia scoured 20 pharmacies in one day but could not find crucial medicines to stop his epileptic 8-year-old from convulsions that caused irreparable brain damage late last year.

The once giggly and alert boy, also called Marcos, could no longer sit on his own and began to shut off from the outside world.

“I called people in the cities of San Cristobal, Valencia, Puerto La Cruz, Barquisimeto, and no one could find the medicine,” Heredia, 43, said in the family’s bare living room in a windy slum overlooking an international airport in the coastal state of Vargas.

“You can’t find the medicines, and the government doesn’t want to accept that.”

Heredia ended up traveling 860 km (540 miles) by bus to the Colombian border to pick up medicine a cousin had bought him in the neighboring country. He was back at work the next day.

Venezuela’s brutal recession is worsening shortages of medicines from painkillers to chemotherapy drugs.

With 85 of every 100 medicines now missing in Venezuela, anti-convulsants are among the toughest drugs to find, Venezuela’s main pharmaceutical association said.

An estimated 2 million to 3 million Venezuelans suffer from epilepsy at some point in their lives, according to Caracas-based support organization LIVECE. Patients have been struggling to find specific anti-convulsive medicines as far back as 2012.

Due to untreated convulsions, progress has evaporated for otherwise functional people and those with severe disabilities who had managed to improve their mobility or speech.

Like Heredia, patients and families try anything they can to get hold of drugs: barter diapers, frantically engage in WhatsApp groups created specifically for pharmaceutical exchanges, use expired medicines or, if they can afford it, ask friends to bring them in from abroad.

But the shortages are so extreme that patients sometimes take medicines ill-suited for their conditions, doctors warn.

Neurologist Beatriz Gonzalez of LIVECE said she was worried about epileptic mothers giving birth to deformed children because they take the wrong medicine, or losing the child because they cannot find the drugs.

‘HEART IN MY MOUTH’

The problem goes much further than just those with epilepsy. Unexpected convulsions can also afflict feverish children, accident victims or people with other neurological conditions.

Two-year-old Carlos Baute unexpectedly started to shake and choke when he had a fever in January. Holding his tongue down with two fingers to keep him from swallowing it, his mother visited multiple underequipped hospitals before one finally treated him.

Baute’s mother said she could not find medication and was worried that her son, an active boy who has recovered and likes to dash around the clinic where he is being treated, may yet suffer another fit.

Leftist President Nicolas Maduro blames the shortages on a right-wing plot to overthrow him, but in a recent speech, he said he had approved “major dollar investments” to boost drug availability, without providing details. Venezuela is set to open three medical labs with Palestine, he added last week.

“(We must) solve this very delicate issue that has been affected by the economic war,” said Maduro.

Venezuela’s Information and Health Ministries, as well as the Social Security Institute, which oversees some hospitals and drug distribution, did not respond to requests for comment.

Compounding medical issues, some families cannot even eat properly.

Leonardo Colmenares, a 6-year-old with epilepsy and a degenerative neurological disease, weighed 10 kg (22 pounds) in mid-2016 but has lost 2 kg in six months as his mother struggles with his recommended diet.

“I sell bracelets and watches, I buy bread and resell it, I dry hair, I do pedicures, I cook, I rent out the washing machine and I iron,” said the single mother, who had to leave her job as a bank analyst to take care of Leonardo.

When Leonardo convulses, she must rush him to a hospital because she has run out of anti-convulsants.

“I can’t just go to a park (with my son) because maybe I’ll suddenly have to rush away,” Torres said, fighting back tears. “I always have my heart in my mouth.”

Click on http://reut.rs/2lp5dQM to see a related photo essay.

(Additional reporting by Alexandra Ulmer and Diego Ore in Caracas; Editing by Alexandra Ulmer, Girish Gupta and Lisa Von Ahn)

Trump gives nod to Republican tax-credit proposal on Obamacare

President Donald Trump delivers his first address to a joint session of Congress. REUTERS/Jim Lo Scalzo

By Yasmeen Abutaleb

WASHINGTON (Reuters) – U.S. President Donald Trump backed the use of tax credits to help people purchase health insurance in a speech to Congress on Tuesday, the first time he signaled support for a key component of House Republican proposals to replace Obamacare.

Republicans, who control the White House and Congress, are united in their opposition to former Democratic President Barack Obama’s signature 2010 healthcare law, but have so far failed to agree on the details of how to replace it.

“We should help Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts,” Trump said. “But it must be the plan they want, not the plan forced on them by our government.”

Democrats are ardently opposed to tampering with Obamacare, which provided coverage to millions of previously uninsured people.

A draft Republican replacement for Obamacare would include an age-based monthly tax credit that Americans who do not get health insurance through their employer could use to buy coverage and take from job to job.

Some Republicans have voiced resistance to that plan.

The president’s comments were also a nod to health insurers – whom Trump met with on Monday – who say tax credits are necessary to keep people in the market.

“The fact that he used the word tax credits is a signal to congressional Republican ranks” that he supports their proposals, said Tom Miller, a resident fellow in health policy at the American Enterprise Institute think tank.

Trump also said Americans should be able to buy insurance across state lines, a proposal favored by health insurers because it would enable them to offer plans in states with fewer regulatory hurdles.

Trump said state governors should be given resources and flexibility on Medicaid, the government health insurance program for the poor, and ensure that “no one is left out.” That appeared to be an attempt to ease concerns from the more than 30 governors who expanded Medicaid coverage under Obamacare.

But Trump offered few details on how he would reconcile House Republican plans to unwind the expansion of Medicaid with promises to maintain coverage for those who gained health insurance under Obamacare.

He also reaffirmed that those with pre-existing conditions should have access to coverage but did not say how that would be accomplished.

(Editing by Nick Tattersall and Peter Cooney)

Trump to lay out plans for America in upcoming speech to Congress

White House aide Omarosa Manigault (center R) directs traffic as U.S. President Donald Trump (center L) welcomes the leaders of dozens of historically black colleges and universities (HBCU) in the Oval Office at the White House in Washington, U.S. February 27, 2017. REUTERS/Jonathan Ernst

By Steve Holland

WASHINGTON (Reuters) – Donald Trump gets a chance to put the rocky start to his presidency behind him on Tuesday night with a speech to the U.S. Congress where he will lay out his plans for the year including a healthcare overhaul and military buildup.

The speech at 9 p.m. (0200 GMT Wednesday) in the chamber of the House of Representatives will be Trump’s biggest chance yet as president to command a large prime-time audience and describe his agenda after a first month in office characterized by missteps, internal dramas and acrimonious disputes with the news media.

The address, which Trump has been writing with aide Stephen Miller and others, will include some gestures toward unifying a country polarized by a bitterly fought election and divided in the early days of his presidency.

An average of recent polls by Real Clear Politics put his approval rating at about 44 percent, low for a new president.

White House spokesman Sean Spicer said the theme of the speech to Congress, which is controlled by Trump’s fellow Republicans, would be “the renewal of the American spirit” and that it would be grounded in how to solve the problems of everyday Americans.

“He will invite Americans of all backgrounds to come together in the service of a stronger and brighter future for our nation,” Spicer told reporters on Monday.

Trump, whose inauguration speech on Jan. 20 painted a dark picture of the United States and referred to “American carnage,” told Reuters last week in an interview that his address would be a speech of optimism.

The president faces a host of questions going into his first speech before a joint session of Congress.

Specifics of his plan to overhaul former Democratic President Barack Obama’s signature healthcare law have not been released. He has yet to describe how to pay for a sharp increase in planned spending on rebuilding U.S. roads and bridges.

His proposals to cut taxes for millions of people and corporations have not been sketched out. His strategy for renegotiating international trade deals remains unclear. He took delivery on Monday of a Pentagon proposal for fighting Islamic State militants and must decide on it in the days ahead.

He seeks a big increase in defense spending but that plan includes a demand that non-defense federal agencies cut funds to offset the cost, painful reductions likely to face opposition in Congress. Some Republicans have said the proposed 10 percent defense spending increase is not enough to meet the military’s needs.

Asked in a Fox News interview broadcast on Tuesday how he would pay for the increased spending, Trump said, “I think the money is going to come from a revved up economy.”

His executive order temporarily banning people from seven Muslim-majority nations on national security grounds stirred protests and was put on hold by federal courts. He was expected to sign a replacement order on Wednesday.

DEMOCRATIC DISPLEASURE

Tim Albrecht, a Republican strategist in Iowa, said the speech was Trump’s best opportunity to date to explain where he wants to take the country. Albrecht doubted there would be much in the way of conciliatory language.

“Despite those at home or in the audience, he’s going to put forward what he believes needs to be done just as he did in the two years he ran for president,” he said. “As with everything in Trump land, conventional wisdom is thrown out the window.”

Democratic lawmakers plan to attend the speech and give their reactions to reporters afterward, as is the custom during similar events, according to congressional aides.

But at least one Democrat – Representative Luis Gutierrez of Illinois, has said he will protest Trump’s speech by refusing to applaud or give him a standing ovation, as also is a custom at presidential speeches.

Democrats aim to show their displeasure with Trump policies by inviting an array of guests to the House visitors’ galleries to highlight their opposition to his agenda.

Democratic Senator Dick Durbin of Illinois has invited Aaima Sayed, a medical student who participates in an Obama administration program that defers deportation for youths brought to the United States illegally. Trump has not given a definitive answer on whether he will leave the program in place.

Other Democratic guests include Muslim immigrants, an advocate of programs for people with disabilities and people who want new gun control measures.

Trump’s guest list illustrates some of his favorite themes: the widows of two California police officers killed by an illegal immigrant, a young woman who benefited from a Florida school choice program and the daughter of a pharmaceutical entrepreneur who founded his company to look for a cure for her illness.

Another guest will be Maureen Scalia, wife of late Supreme Court Justice Antonin Scalia, a hero to conservatives whom Trump hopes to replace on the court with Neil Gorsuch.

House Democratic leader Nancy Pelosi told reporters on Monday that if Trump’s address was anything like his inaugural speech, “it will be a very sad evening for our country.”

(Additional reporting by Richard Cowan, Ayesha Rascoe, Jeff Mason, Emily Stephenson, Doina Chiacu; Editing by Peter Cooney and Frances Kerry)

U.S. healthcare costs to escalate over next decade: government agency

doctor holds hand of patient

WASHINGTON (Reuters) – The cost of medical care in the United States is expected to grow at a faster clip over the next decade and overall health spending growth will outpace that of the gross domestic product, a U.S. government health agency said on Wednesday.

A report by the U.S. Centers for Medicare and Medicaid Services (CMS) cited the aging of the enormous baby boom generation and overall economic inflation as prime contributors to the projected increase in healthcare spending.

Overall healthcare spending will comprise 19.9 percent of the economy in 2025, up from 17.8 percent in 2015, the report forecast. The pace of growth in U.S. spending on health is expected to pick up in 2017, increasing 5.4 percent over 2016. That compares with an estimated 4.8 percent spending uptick in 2016. Spending for 2016 was estimated at $3.4 trillion.

When the final numbers are in, the growth in prescription drug spending for 2016 is expected to have slowed to 5 percent from 9 percent in 2015. However, CMS has forecast growth of 6.4 percent per year between 2017 and 2025, in part because of spending on expensive newer specialty drugs, such as for cancer and multiple sclerosis.

The projections for 2016 to 2025 were made assuming that the Affordable Care Act (ACA), former President Barack Obama’s signature healthcare law widely known as Obamacare, would remain intact. It does not take into account likely changes to the law.

The Republican-led Congress and President Donald Trump have vowed to repeal and replace the ACA, but a viable replacement plan has yet to emerge.

Trump signed an executive order on his first day in office last month to freeze regulations and enable government agencies to take other steps to weaken Obamacare.

The ACA expanded Medicaid, the government health insurance program for the poor, in more than 30 states and set up private healthcare exchanges that enabled previously uninsured people to buy health insurance. After high enrollment between 2014 and 2015, Medicaid and private health insurance spending were expected to have slowed in 2016.

But spending on Medicare, the government health insurance program for the elderly, is expected to grow between 2017 and 2025 as a larger elderly population requires more medical services.

The overall insured rate of the population is expected to reach 91.5 percent in 2025, up from 90.9 percent in 2015, the report said.

(Reporting By Yasmeen Abutaleb; Editing by Tom Brown)

With eye on Obamacare, Price takes helm as U.S. health secretary

Tom Price

By Susan Cornwell

WASHINGTON (Reuters) – Tom Price was sworn in as U.S. secretary of health on Friday, putting in place a determined opponent of Obamacare to help President Donald Trump fulfill his pledge to dismantle his predecessor’s law and reshape the country’s healthcare system.

As head of the Department of Health and Human Services (HHS) Price has the authority to rewrite rules implementing the 2010 Affordable Care Act, also known as Obamacare. He could move quickly to rework the regulations while waiting for Republicans in Congress to keep their pledge to scrap the law entirely.

The Republican president signed an order on Jan. 20, his first day in office, to freeze regulations and take other steps to weaken the law enacted by former Democratic President Barack Obama, a directive that will fall largely on Price. But Trump said in a recent Fox News interview that a replacement for the law may not come until next year.

Trump said on Friday the effort was a “difficult process” but could now get going with Price in place.

“Now we get down to the final strokes,” he told reporters at a separate news conference at the White House alongside visiting Japanese Prime Minister Shinzo Abe. He did not offer more details but said the country would end up with “tremendous healthcare at a lower price.”

Republicans, who have long viewed Obamacare as federal overreach and who have the majority in Congress, are trying to craft a replacement but have not agreed on one. Twenty million Americans gained health insurance under the law.

“Having Dr. Tom Price at the helm of HHS gives us a committed ally in our work to repeal and replace Obamacare,” said U.S. House of Representatives Speaker Paul Ryan, who has vowed to pass a new plan this year.

Price, a member of the House since 2005 who chaired the budget committee, offered legislation in 2015 to repeal Obamacare and replace it with age-adjusted tax credits for the purchase of health insurance.

While Price’s fellow Republicans have controlled the House since 2011, they did not advance his bill and it was not considered by the full chamber.

The Senate voted 52-47 earlier on Friday to approve Price, a former orthopedic surgeon, to oversee the HHS, which has an annual budget of more than $1 trillion.

Price’s nomination was dogged by questions about his trading in hundreds of thousands of dollars in health company stocks while working on healthcare legislation. Democrats accused him of making misleading statements. Price defended his actions.

Democrats also criticized Price for his opposition to Obamacare, his ideas about restructuring the Medicare program for the elderly and disabled, and his opposition to Planned Parenthood, an organization that provides abortions and other affordable healthcare and education services.

With Price confirmed, the Senate is expected to vote on Monday on Trump’s U.S. Treasury secretary designate, Steven Mnuchin.

(Additional reporting by Susan Heavey and Steve Holland in Washington, and Brendan O’Brien in Milwaukee; Editing by Bernadette Baum and Frances Kerry)

Medical students, faculty rally to try to save Obamacare

Medical students protesting for obamacare

By Bob Chiarito

CHICAGO (Reuters) – Hundreds of medical students and faculty members gathered at Northwestern University’s school of medicine in Chicago on Monday to voice their opposition to the dismantling of Obamacare.

The demonstration was part of a larger White Coats for Coverage effort organized by medical students across the country and came a day before the annual deadline to enroll in the Affordable Care Act (ACA), former President Barack Obama’s healthcare law.

“The ACA is not perfect, but pulling the rug out from under the feet of our most vulnerable patients is not the answer,” Dr. Bruce Henshaw, a faculty member at Northwestern’s Feinberg School of Medicine, told the group of around 600 people.

“We will not stand idly by as our patients lose their rights. We will not stop today. We will write and call our representatives to ensure this doesn’t happen.”

Students organized the event. Northwestern University spokeswoman Marla Paul said the school had no official position on the issue.

Photos on social media showed students rallying at numerous universities and cities.

“Proud to join my Yale colleagues to collectively say #protectourpatients. Improve the ACA, DON’T repeal it,” Ryan Murphy, who shared photos of a rally at Yale University, said on Twitter.

Republican President Donald Trump’s first executive order, signed hours after taking office, directed the federal government to scale back regulations, taxes and penalties under the ACA.

Republican Representative Tom Price, Trump’s nominee to lead the Department of Health and Human Services, has said an overhaul of Obamacare will initially focus on individual health plans sold through online exchanges and the Medicaid health insurance program for low-income Americans.

Trump has said he wants to keep some elements of the program, such as allowing young adults to be covered under their parents’ insurance. He favors plans that use health savings accounts and sale of insurance across state lines.

More than 8.8 million Americans were signed up for 2017 coverage under the ACA through HealthCare.gov as of Jan. 14, according to the site, up from around 8.7 million sign-ups as of Jan. 14 last year.

Arturo Salow, a second year student at Northwestern from Miami, Florida, urged people to sign up for ACA coverage before Tuesday’s deadline, saying more enrollees would make a rollback more challenging for Republicans.

“I’d advise any patient to sign up immediately,” Salow said. “If they are going to take away coverage, let’s make it as difficult as possible.”

(Editing by David Gregorio)

Trump vows ‘insurance for everybody’ in replacing Obamacare

Donald Trump at conference disucssing Obamacare

WASHINGTON (Reuters) – U.S. President-elect Donald Trump aims to replace Obamacare with a plan that would envisage “insurance for everybody,” he said in an interview with the Washington Post published on Sunday night.

Trump did not give the newspaper specifics about his proposals to replace Democratic President Barack Obama’s signature health insurance law, but said the plan was nearly finished and he was ready to unveil it alongside the leaders of the Republican-controlled Congress. The Republican president-elect takes office on Friday.

“It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon,” Trump told the Post, adding he was waiting for his nominee for health and human services secretary, Tom Price, to be confirmed.

The plan, he said, would include “lower numbers, much lower deductibles,” without elaborating.

“We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

Trump was also quoted as saying in the interview that he would target pharmaceutical companies over drug pricing and insist they negotiate directly with the Medicare and Medicaid government health plans for the elderly and poor.

U.S. House Republicans won passage on Friday of a measure starting the process of dismantling the Affordable Care Act, popularly known as Obamacare, despite concerns about not having a ready replacement and the potential financial cost of repealing the law.

With the vote, Republicans began delivering on their promise to end Obamacare, also a campaign pledge of Trump, who has called the program a “disaster.”

The law, which expanded health coverage to some 20 million people, has been plagued by increases in insurance premiums and deductibles and by some large insurers leaving the system.

Republicans have called Obamacare federal government overreach and have sought to undermine it in Congress and the courts since it was passed by Democratic majorities in the House and Senate in 2010.

Democrats say Obamacare has allowed growing numbers of Americans to get medical insurance and helped slow the rise in healthcare spending.

(Writing by Mary Milliken; Editing by Will Dunham and Peter Cooney)

U.S. court puts Obamacare case on hold until Trump takes office

President-elect Donald Trump

By Lawrence Hurley

WASHINGTON (Reuters) – A federal appeals court on Monday brought to an end President Barack Obama’s bid to overturn a ruling that threatens to gut his signature healthcare law by putting the case on hold until after President-elect Donald Trump, who aims to repeal Obamacare, takes office.

The Obama administration had appealed a judge’s May ruling favoring the challenge filed by Republicans in the U.S. House of Representatives against a key part of the 2010 law. But the U.S. Court of Appeals for the District of Columbia Circuit agreed to a request by the Republicans to delay its consideration of the government’s appeal until after Trump takes office on Jan. 20.

The Obama administration opposed the move.

If the law is repealed by Congress, the case would be moot. The court’s decision to put the case on hold will not have an immediate effect on the law, as the lower court ruling was put on hold pending the appeal. The court said both sides should provide an update on the status of the case by Feb. 21.

The challenge targeted government reimbursements to insurance companies to compensate them for reductions that the law required them to make to customers’ out-of-pocket medical payments.

Trump has said he favors repealing and replacing Obamacare but would consider retaining certain elements.

The law has enabled millions of previously uninsured Americans to obtain health insurance, but Republicans condemn Obamacare as a government overreach and have mounted a series of legal challenges.

The Obama administration appealed U.S. District Judge Rosemary Collyer’s ruling that the government cannot spend billions of dollars in federal funds without congressional approval to provide subsidies under the healthcare law to private insurers to help people afford medical coverage.

The House Republicans argued that the administration violated the U.S. Constitution because it is the legislative branch, not the executive branch, that authorizes government spending.

The Obama administration has interpreted the provision as a type of federal spending that does not need to be explicitly authorized by Congress.

The U.S. Supreme Court in 2012 and 2015 issued major rulings authored by conservative Chief Justice John Roberts that preserved Obamacare and rejected conservative challenges.

(Reporting by Lawrence Hurley; Editing by Will Dunham)