Despite a relentless eight-year Republican campaign to repeal the Affordable Care Act, it remains largely intact. Through it, nearly 20 million Americans gained health insurance. Many others benefited from new protections, such as ensuring that people can’t be denied coverage because of pre-existing conditions and the elimination of limits on lifetime benefits that has protected thousands of vulnerable Americans from bankruptcy.

Unable to achieve legislative success, Republicans have found a new strategy to remake health policy: deploying administrative burdens to make it harder for millions of Americans to gain access to health care.

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