On Monday afternoon, House Republicans unveiled their long-awaited legislation as part of House Republicans effort to repeal and replace Obamacare through the reconciliation process. The measure would roll back the government’s health care role and is expected to result in fewer people having insurance coverage.
Upon releasing the legislation, House Energy and Commerce Committee Chairman Greg Walden said: “After years of Obamacare’s broken promises, House Republicans today took an important step. We’ve spent the last eight years listening to folks across this country, and today we’re proud to put forth a plan that reflects eight years’ worth of those conversations with families, patients, and doctors. Simply put, we have a Better Way to deliver solutions that put patients – not bureaucrats – first, and we are moving forward united in our efforts to rescue the American people from the mess Obamacare has created.
“With today’s legislation, we return power back to the states – strengthening Medicaid and prioritizing our nation’s most vulnerable. We provide the American people with what they’ve asked for: greater choice, lower cost, and flexibility to choose the plan that best suits their needs. Today is just the first step in helping families across this country obtain truly affordable health care, and we’re eager to get this rescue mission started.”
The plan would dismantle the key aspects of ObamaCare, including subsidies to help people buy coverage, the law’s fines on people who don’t purchase health insurance, the expansion of Medicaid, and drop the plan to tax employer-sponsored plans. The bills can be found here and here.
A breakdown of core aspects removed from the existing law (courtesy of Axios):
- All Obamacare taxes
- All Obamacare subsidies, including its premium tax credit
- Individual, employer mandate penalties
- “Cadillac tax”
- No longer will limit the tax break for employer-sponsored health coverage
- No payments to insurers for cost-sharing reductions
- Selling insurance across state lines (can’t be done in the “reconciliation” bill)
- Medical malpractice reform (can’t be done in the “reconciliation” bill)
What is being added:
- Pre-existing condition coverage
- Continuous coverage — 30 percent penalty if people don’t keep themselves insured
- Special fund to help states set up “high-risk” pools, fix their insurance markets, or help low-income patients
- Enrollment in expanded Medicaid will be frozen
- Current enrollees can stay until 2020, and keep getting extra federal funds, until they leave the program on their own
- Medicaid will change to “per capita caps” (funding limits for each person) in fiscal year 2020
- A new, refundable tax credit will be available in 2020 to help people buy health insurance
- Covers five age groups — starts at $2,000 for people in their 20s, increases to $4,000 for people in their 60s
- It’s not means tested, but phased out for upper-income people (starting at $75,000 for individuals, $150,000 for families)
- Insurers can charge older customers five times as much as young adults
At its core, in place of the existing Affordable Care Act legislation, republicans will implement a system centered on a tax credit to help people buy insurance. That tax credit would range from $2,000 to $4,000 annually increasing with age. That system would provide less financial assistance for low-income and older people than ObamaCare, but could give more assistance to younger people and those with somewhat higher incomes.
Democrats have warned that between the phasing out of ObamaCare’s Medicaid expansion and the smaller tax credit for low income people, coverage would be put at risk for many of the 20 million people who gained it from ObamaCare. As The Hill adds, Republicans acknowledge that their plan will cover fewer people, but note that unlike ObamaCare, they are not forcing people to buy coverage through a mandate. They say their system is less intrusive and provides people a tax credit without mandates or a range of tax increases.
While some republicans such as House Ways and Means Chairman Kevin Brady are confident the bill will pass with full Republican support despite recent party infighting over the details, the measure faces a rocky path, particularly in the Senate.
Earlier on Monday, four Republican senators – Sens. Rob Portman, Shelley Moore Capito, Cory Gardner and Lisa Murkowski – objected to an earlier version of the House bill, saying that it failed to protect ObamaCare’s Medicaid expansion, saying they won’t support a bill that takes the same approach to the program as a leaked Obamacare repeal and replacement bill did. However, under the proposed bill, the repeal of the Medicaid expansion would not take effect until 2020, and Republicans would grandfather in current enrollees so that they can stay on the program. Once 2020 arrives, the federal government will no longer provide the extra federal funds that allow for expansion.
As this is unlikely to solve the senators’ problems with the bill, the proposed plan may be dead on arrival.
That plan has drawn objections from more centrist Republican senators too, who want to protect the expansion and are worried about constituents losing coverage and their states losing federal funds.
House Republicans have also objected to the plan, with Conservatives in the House Freedom Caucus calling the bill’s tax credit is a “new entitlement.” They have enough votes to kill the bill, but it remains to be seen whether they will actually vote against it.
As previously leaked, the bill would maintain ObamaCare’s protections for people with pre-existing conditions, who could still not be denied coverage. Instead of ObamaCare’s mandate, the bill would seek to incentivize healthy people to sign up by allowing insurers to charge people 30 percent higher premiums if they have a gap in coverage. The measure also repeals ObamaCare’s taxes, such as the medical device tax and health insurance tax, starting in 2018.
Finally, The Hill also notes that the bill scraps a controversial Republican proposal in earlier drafts to start taxing some employer-sponsored health insurance. Instead, the measure would keep ObamaCare’s “Cadillac tax” on generous healthcare plans starting in 2025, in order to prevent that legislation from adding to the deficit in that decade.
House committees planned votes on the legislation Wednesday at 10:30am. That will launch perhaps the year’s defining battle in Congress, and GOP success is by no means assured because of internal divisions.
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Author: Tyler Durden