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Republican Opposition To Their Party’s Obamacare Replacement Bill Grows

 

Leigh Ann Caldwell and Frank Thorp V
Image: U.S. House Majority Leader Kevin McCarthy, U.S. House Speaker Paul Ryan, and U.S. Representative Greg Walden hold a news conference on Capitol Hill in Washington© (L-R)U.S. House Majority Leader Kevin McCarthy, U.S. House Speaker Paul Ryan, and U.S. Representativ… Image: U.S. House Majority Leader Kevin McCarthy, U.S. House Speaker Paul Ryan, and U.S. Representative Greg Walden hold a news…

 

 

Republican leaders launched a full-court press Tuesday to rally support for the party’s newly revealed health care plan as criticism mounted from rank-and-file members and prospects for the legislation appeared uncertain at best.

Vice President Mike Pence traveled to Capitol Hill to sell the GOP leadership’s plan to repeal and replace the Affordable Care Act and met with those lobbing the heaviest criticism at the bill. President Trump met with Republican leaders at the White House to discuss the bill’s passage.

Meanwhile, Health and Human Services Secretary Tom Price spoke at length during the daily briefing at the White House. And the chairmen of the relevant House committees, Reps. Kevin Brady and Greg Walden, who wrote the bill, held two news conferences (including one with House Speaker Paul Ryan) as they blanketed television news shows to sell the plan.

The push came after many Republicans balked at the details of the bill when it was released late Monday. Some called the proposal “Obamcare Lite” while others questioned whether it would provide adequate coverage, demonstrating the challenges facing GOP leadership faces in trying to pass the legislation.

While the topic is complicated, the math for passing the bill is simple. Republican leaders need to find 218 votes in the House and 50 in the Senate (with Pence available as a tie-breaker). With little to no support expected from Democrats, GOP leaders can’t afford many defections.

Tuesday’s leadership push also comes as conservative groups with deep pockets and millions of activist members have signaled their opposition to the replacement bill, putting more pressure on jittery Republicans.

The complaints coming from Republicans cut across the party’s ideological fissures. Small-government conservatives have criticized it as another version of Obamacare. They say that the age-based tax credits to help people purchase health insurance are no different from the income-based subsidies currently offered through the Affordable Care Act.

“This is not the Obamacare repeal bill we’ve been waiting for. It is a missed opportunity and a step in the wrong direction,” said Sen. Mike Lee, R-Utah, said, adding that it was a “missed opportunity” to go big and bold.

What also concerns these conservatives, many of whom are members of the tea-party minded Freedom Caucus, is that it’s not a full repeal of the Affordable Care Act, noting that it keeps in place the Medicaid expansion until 2020 and doesn’t actually get rid of the Obamacare exchanges. And they see little evidence that it will actually lower health care costs.

“Our plea: Repeal and replace with a patient-centered, doctor-centered plan,” said Rep, Jim Jordan, R-Ohio, and member of the Freedom Caucus, which has a membership of about 40 Republicans. Some of these conservative members have authored their own replacement bill, and they want it introduced alongside the House leadership bill.

On the opposite end of the Republican spectrum, several members of the Senate have expressed concerns about the the changes to the Medicaid expansion, which after 2020 will change from an income based requirement to a limit based on population. They say that it is too drastic of a roll-back of the Medicaid expansion.

Four Republicans in the Senate, including Rob Portman of Ohio, who comes from a state that expanded Medicaid, and Shelly Moore Capito of West Virginia, another state with a large Medicaid population, have voiced their concerns about that part of the plan.

Also challenging passage of the AHCA is the one-year defunding of Planned Parenthood. Two Republican senators, Lisa Murkowski of Alaska and Susan Collins of Maine, have expressed reservations about that feature. “I don’t think the Planned Parenthood defund should be in the ACA bill that we’re dealing with,” said Murkowski.

But Republican leaders are indicating that major changes to the bill are unlikely, even though President Donald Trump tweeted Tuesday morning that the health care bill is out “for review and negotiation.” But it’s unlikely that any negotiation for changes will occur.

Sen. John Thune, R-S.D. and a member of Republican leadership, said that the Republican opposition is “leverage.”

“Everybody right now is trying to leverage their position … but when push comes to shove, it’s going to either be a vote for a status quo or a vote to repeal this and to a better way,” Thune said. “We have a difference of opinion right now but I think before this is all said and done consensus will emerge.”

The House Energy and Commerce Committee and the Ways and Means Committee will debate the bill Wednesday, likely the only window for any altering the bill, and that would likely amount to small tinkering, not structural changes.

Chairman Brady, head of the House Energy and Commerce Committee, defended the bill as taking conservative principles but he also put down a marker for critical Republicans.

“As Republicans we have a choice: We can act now or we can keep fiddling around and squander the opportunity to repeal Obamacare and begin a new chapter,” Brady said.

But some Republicans are holding out hope that President Trump will be on their side.

“Everyone wonders. We’re all waiting to hear that,” said Rep. Dave Brat, R-Virginia, when asked if Trump is on the same page as Speaker Ryan and and the authors of the bill. “I haven’t heard him come down in thunder in approval on this.”

The president called it a “wonderful” bill in a Tuesday morning Tweet, but also noted it was out for “review and negotiation.

Republicans are also taking a beating for releasing a bill without an official score on how much the bill will cost. They say the non-partisan Congressional Budget Office will release a budget outlook before it comes before the House floor.

“I would want to know the score, you know, what is the coverage and what is the cost, absolutely,” said Sen. Bill Cassidy, R-Louisiana. “I’m trying to be diplomatic.”

Influential conservative groups have also sharply criticized the bill. The Charles and David Koch-backed groups Americans for Prosperity and Freedom Partners came out against it because of the tax credits but also because of the penalty for people who don’t purchase insurance. The Republican plan attempts to incentivize continuous health care coverage by allowing health insurance companies to charge an extra 30 percent on premiums.

Hilgemann calls it a mandate for coverage but one where the penalty is reaped by the insurance companies instead of the government, like in Obamacare.

“We’re really focused on telling the story of decades’ worth of work that AFP has done to see real transformative health care reform in this country. What we saw come out of the House last night just falls short of that,” said Luke Hilgemann, CEO of Americans for Prosperity. “This law is broken we need a better solution and what we’ve seen out of Washington so far is not that.”

AFP has been organizing around its opposition to Obamacare for years, using that as its top motivating factor in getting conservatives involved in its organization and to the polls. Their opposition could mobilize its members to pressure Republican lawmakers, further complicating the law’s passage.

And Club for Growth and the Heritage Foundation, two other conservative groups with influence among Republican members of Congress, also came out strongly against it. President David McIntosh called it a “warmed-over substitute for government-run health care.”

“The problems with this bill are not just what’s in it, but also what’s missing: namely, the critical free-market solution of selling health insurance across state lines,” McIntosh, who dubbed the measure “RyandCare,” said. “Republicans should be offering a full and immediate repeal of Obamacare’s taxes, regulations, and mandates, an end to the Medicaid expansion, and inclusion of free-market reforms, like interstate competition.” (NBC News)

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BREAKING NEWS: House Republicans Unveil Obamacare Replacement Bill

 

Maureen Groppe
                                   © Provided by USA Today

House Republicans released draft legislation Monday to replace former president Barack Obama’s signature health care law, proposing to phase out the Affordable Care Act’s Medicaid expansion and change the law’s subsidies for private insurance.

The bill’s details released Monday do not say how many people would have coverage compared with Obamacare. But federal support would be reduced to allow Republicans to repeal the law’s tax increases on the wealthy, insurance companies, drugmakers and others.

The bill would also repeal the requirements that most people buy insurance and larger employers provide it.

It would not repeal the popular provision barring insurance companies from denying covering to people with pre-existing health problems. Instead, to keep people from buying coverage only when they need it, insurers could raise premiums 30% for those jumping back into the market.

The legislation is already under attack not only from Democrats, but from some Republicans who have raised concerns about eliminating coverage for millions of people who got coverage under the bill’s expanded Medicaid eligibility. In addition, some of the most conservative Republicans have warned that the replacement tax credits the bill provided to help people buy insurance would be just another entitlement program.

House committees are expected to take up the legislation later this week.

“Our legislation transfers power from Washington back to the American people,” said Rep. Kevin Brady, the Texas Republican who heads the House Ways and Means Committee. “We dismantle Obamacare’s damaging taxes and mandates so states can deliver quality, affordable options based on what their patient populations need, and workers and families can have the freedom and flexibility to make their own health care choices.”

States that expanded Medicaid under the Affordable Care Act to people earning up to 138% of poverty could still get federal funding for those enrolled before January 2020. But if those beneficiaries left the program, the federal funding would disappear.

States would also no longer receive an open-ended federal match on the amount they spend on all Medicaid beneficiaries. Instead, they would be given a set amount based on the number of enrollees.

Four Republican senators — Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska — said Monday they were concerned that an early draft of the bill had not provided enough “stability and certainty” for families covered by the Medicaid expansion. They said any replacement plan offer a “stable transition period and the opportunity to gradually phase-in their populations to any new Medicaid financing structure.”

It was not immediately clear whether the bill unveiled Monday night would put those concerns to rest.

Some conservative Republicans have complained about the subsidies that would replace the tax credits the ACA provides to help people earning up to 400% of poverty buy private insurance.

The GOP alternative offers refundable credits which become more generous with age. Unlike an earlier draft, the credits phase out at higher income levels. But at lower income levels, recipients can still receive a larger credit than the amount of taxes they owe, which has raised concerns among some Republicans.

The tax credits would range from $2,000 to $14,000 a year.

Those receiving tax credits can use them to purchase any insurance plans, not just those sold on the exchanges created by the Affordable Care Act. That would include purchasing “catastrophic” plans which offer limited coverage.

Democrats across the board have promised to fight any changes to the law that would scale back health care coverage.

House Ways and Means Committee Chairman Rep. Kevin Brady, R-Texas, right, accompanied by Rep. Cathy McMorris Rodgers, R-Wash., and House Speaker Paul Ryan of Wis., talks about restructuring the Affordable Care Act, Tuesday, Feb. 14, 2017, during a news conference on Capitol Hill in Washington.© AP Photo/J. Scott Applewhite House Ways and Means Committee Chairman Rep. Kevin Brady, R-Texas, right, accompanied by Rep. Cathy McMorris Rodgers, R-Wash., and House Speaker Paul Ryan of Wis., talks about restructuring the Affordable…

(USA Today)
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