House GOP discusses Obamacare replacement ideas — but doesnft call them a plan
By Mike DeBonis and Kelsey Snell
February 16 at 6:38 PM - Washington Post
House Republicans came out of a highly anticipated
meeting on health care Thursday morning with some new details on the options GOP
leaders are considering to replace the Affordable Care Act, but not with the
fully formed plan that those leaders and President Trump have promised.
The meeting in the Capitol basement included
presentations from leaders of key House committees and Health and Human Services
Secretary Tom Price, and it was intended to give lawmakers more details ahead of
a week-long recess where many of them will be meeting constituents eager
for details on what will replace the health-care law they have pledged to
repeal.
According to numerous lawmakers and aides in the
room, as well as a policy memo distributed afterward, the House leaders laid out
elements of a repeal-and-replace plan — including long-standing Republican
concepts like health savings accounts, tax credits and state high-risk pools for
the chronically sick. But they did not detail how those elements would fit
together or get passed into law.
gItfs sort of a smorgasbord right now,h said Rep.
Daniel Webster (R-Fla.).
House Speaker Paul D. Ryan (R-Wis.) told reporters
Thursday that legislation to overhaul the ACA would be introduced later this
month, after lawmakers return from the recess. He pointed to recent news that
major insurer Humana would stop selling individual plans on ACA-mandated
state marketplaces.
gIt is getting worse by the day, and it will keep
getting worse unless we act,h he said. gWe need to rescue people from this
collapsing law, and we need to replace it with a true patient-centered
system.h
What was clear Thursday is that Trump intends to take
a hands-off approach to overhauling the health-care system — for now, at least.
He had earlier pledged, including to The Washington Post shortly before his
inauguration, that he had a health-care plan gvery much formulated down to the
final strokesh to be introduced once Price was confirmed. At a news conference
Thursday, Trump again said his plan was in the gfinal stagesh and would be
submitted to Congress in March.
The problem for the president and Republicans is that
the ideas presented to lawmakers Thursday are sparking major divisions among
their party. Medicaid, for instance, is a flash point between hard-line
conservatives who want to significantly roll back federal spending and members
from states that took advantage of the ACAfs Medicaid expansion and are now wary
of reducing coverage.
Another significant division is over how to structure
tax breaks to encourage individuals to buy insurance plans. House Speaker Paul
D. Ryan (R-Wis.) and other House leaders say they favor refundable tax credits,
while many conservatives say they prefer less expansive — and expensive — tax
deductions.
Rep. Raúl R. Labrador (R-Idaho), who backs
deductions, said of the tax-incentive debate: gTherefs no consensus. We had two
minutes to discuss it.h
Even some of the committee leaders who are crafting
the health-care legislation acknowledged after the meeting that plenty remains
unresolved.
gWefre talking different options,h said Rep. Patrick
J. Tiberi (R-Ohio), chairman of the Ways and Means subcommittee on health. gWe
are working together — this is not top-down; this is bottom-up.h
Asked when legislative text would be released, Tiberi
said, gTo be determined.h
Price, who served in the House until his confirmation
last week and penned an ACA alternative plan, told members that Trump is gall
inh on repealing the Obama-era law and replacing it gconcurrently.h But he
indicated that the House would take the lead in that process and did not endorse
specific overhaul elements. He also gave only a broad overview of
regulatory steps he would be taking as secretary to address turmoil in the
insurance markets.
At one point, according to an attendee of the party
meeting, Price quipped that he used to be frustrated when he was a congressman
and Cabinet secretaries gave vague answers to his questions. Now, he said, as
secretary, he is obligated to be vague.
Ryan and other lawmakers acknowledged important
details remain unknown — including, crucially, how much the Republican health
proposals will cost. Ryan said the Congressional Budget Office and the Joint
Committee on Taxation are gscoringh the fiscal effect of the various
elements.
The release of cost estimates could widen fissures
between hard-line conservatives, who wish to keep federal spending to a minimum,
and the rest of the House GOP, who seem to believe spending will be necessary to
prevent turmoil in the insurance markets.
gWe did learn a lot,h Rep. Pete Sessions (R-Tex.),
the House Rules Committee chairman, said of the meeting. gThey did not overlay
the money, and thatfs the big question.h
Rep. Kevin Brady (R-Tex.), the chairman of the Ways
and Means Committee, said he discussed options for individual tax credits and a
possible expansion of the existing system of health savings accounts that allow
individuals to set aside untaxed income for health care.
gWefre really looking at a whole range of options,h
he said.
Rep. Greg Walden
(R-Ore.), chairman of the Energy and Commerce Committee, presented options to
overhaul the Medicaid system, but said no final decisions were made.
Members discussed whether to institute per capita
limits on how much money the government would put into the Medicaid system or to
shift to a gblock granth where states receive a lump sum of money to distribute
as they see fit.
The memo distributed to lawmakers says that states
would be able to choose whether to receive a block grant or remain in the
traditional, capped program. But the states that participated in the ACAfs
Medicaid expansion would eventually lose out on much of the federal funding they
have used to cover millions of Americans.
Under the ACA, the federal government covers more than
90 percent of the costs to insure the expanded Medicaid population. The GOP
blueprint suggests slowly stepping down that percentage over an undetermined
period of time, after which states gwould be reimbursed at their traditional
match rates for these beneficiaries.h Those rates vary from state to state; some receive as little as
50 percent, meaning individual states could lose hundreds of millions
of dollars a year in federal reimbursements under the GOP proposal.
Rank-and-file members leaving the meeting largely
said they felt reassured about the path forward. But most said what was
presented Thursday did not constitute a complete plan.
gI think therefs a road map,h said Rep. Bill Huizenga
(R-Mich.). gWhether wefre going to be taking a six-lane highway or a four-lane
highway, I donft think thatfs been determined yet, but we know the direction
that we want to go.h