House Republicans Unveil Plan to Replace Health Law
By ROBERT PEAR and THOMAS KAPLAN
MARCH 6, 2017 - The New York Times
WASHINGTON
— House Republicans on Monday unveiled their long-awaited plan to repeal and
replace the Affordable Care Act, scrapping the mandate for most Americans to
have health
insurance in favor of a new system of tax credits to induce people to buy
insurance on the open market.
The
bill sets the stage for a bitter debate over the possible dismantling of the
most significant health
care law in a half-century. In its place would be a health law that would be
far more oriented to the free market and would make far-reaching changes to a
vast part of the American economy.
The House Republican bill would roll back the expansion of
Medicaid
that has provided coverage to more than 10 million people in 31 states,
effective in January 2020. The bill would effectively scrap the Affordable Care
Actfs unpopular gindividual mandate,h eliminating tax penalties for people who
go without health insurance. The requirement for larger employers to offer
coverage to their full-time employees would also be eliminated.
People who let their insurance coverage lapse, however,
would face a significant penalty: Insurers could increase their premiums by 30
percent. In that sense, Republicans would replace a penalty for not having
insurance with a new penalty for allowing insurance to lapse.
The bill would also cut off
federal funds to Planned Parenthood clinics through Medicaid and other
government programs for one year. House Republican leaders intend to keep three
of the Affordable Care Actfs most popular provisions: the prohibition on barring
insurance for pre-existing conditions or imposing lifetime coverage caps, and
the rule allowing young people to remain on their parentsf health plans until
age 26.
But Republicans hope to undo major
parts of President Barack Obamafs signature domestic achievement, including
income-based tax credits that help millions of Americans buy insurance, taxes on
people with high incomes and the penalty for people who do not have health
coverage.
Medicaid recipientsf open-ended entitlement to health care
would be replaced by a per-person allotment to the states. And people with
pre-existing medical conditions would face new uncertainties in a more
deregulated insurance market.
gObamacare is a sinking ship, and the legislation
introduced today will rescue people from the mistakes of the past,h said
Representative Kevin McCarthy of California, the majority leader.
Democrats denounced the effort as a
cruel attempt to strip Americans of their health care.
gRepublicans will force tens of millions of families to
pay more for worse coverage — and push millions of Americans off of health
coverage entirely,h said Representative Nancy Pelosi of California, the
Democratic leader.
Two House committees — Ways and Means and Energy and
Commerce — plan to take up the legislation on Wednesday. House Republicans hope
the committees will approve the measure this week, clearing the way for the full
House to act on it before a spring break scheduled to begin on April 7. The
outlook in the Senate is less clear. Democrats want to preserve the Affordable
Care Act, and a handful of Republican senators have expressed serious concerns
about the House bill.
Under the House Republican plan,
the income-based tax credits provided under the Affordable Care Act would be
replaced with credits that would rise with age because health care becomes more
expensive as people grow older. In a late change, the plan reduces the tax
credits for individuals with annual incomes over $75,000 and married couples
with incomes over $150,000.
Republicans did not offer any estimate of how much their
plan would cost, or how many people would gain or lose insurance. The two House
committees plan to vote on the legislation without having estimates of its cost
from the Congressional Budget Office, the official scorekeeper on Capitol
Hill.
But they did get the support from
President Trump that they badly need to win House passage.
gObamacare has proven to be a disaster with fewer options,
inferior care, and skyrocketing costs that are crushing small business and
families across America,h said the White House press secretary, Sean Spicer.
gToday marks an important step toward restoring health care choices and
affordability back to the American people.h
The release of the legislation is
a step toward fulfilling a campaign pledge — repeal and replace — that has
animated Republicans since the Affordable
Care Act passed in 2010. But it is far from certain Republican lawmakers
will be able to get on the same page and repeal the health measure.
On Monday, four Republican
senators — Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory
Gardner of Colorado and Lisa Murkowski of Alaska — signed a letter saying a
House draft that they had reviewed did not adequately protect people in states
like theirs that have expanded Medicaid under the Affordable Care Act.
Three conservative Republicans in the Senate — Mike Lee of
Utah, Rand Paul of Kentucky and Ted Cruz of Texas — had already expressed
reservations about the Housefs approach.
In the House, Republican leaders
will have to contend with conservative members who have already been vocal about
their misgivings about the legislation being drawn up. gObamacare 2.0,h
Representative Justin Amash, Republican of Michigan, posted
on Twitter on Monday.
Representative Mark Meadows, Republican of North Carolina
and the chairman of the conservative House Freedom Caucus, also offered a
warning on Monday, joining with Mr. Paul to urge that Republican leaders pursue
a gclean repealh of the health care law. Even the new approach they view as a
big government program.
gConservatives donft want new taxes, new entitlements and
an eObamaCare Litef bill,h they wrote
on the website of Fox News. gIf leadership insists on replacing ObamaCare with
ObamaCare-lite, no repeal will pass.h
The move to strip Planned Parenthood of funding and the
planfs provisions to reverse tax increases on the high-income taxpayers will
also expose Republicans in more moderate districts to Democratic attacks.
The bill would provide each state
with a fixed allotment of federal money for each person on Medicaid, the
federal-state program for more than 70 million low-income people. The federal
government would pay different amounts for different categories of
beneficiaries, including children, older Americans and people with
disabilities.
The bill would also repeal
subsidies that the government provides under the Affordable Care Act to help
low-income people pay deductibles and other out-of-pocket costs for insurance
purchased through the public marketplaces. Eliminating these subsidies would
cause turmoil in insurance markets, insurers and consumer advocates say.
However, the House Republicans
would provide states with $100 billion over nine years, which states could use
to help people pay for health care and insurance.
The tax credits proposed by House Republicans would start
at $2,000 a year for people under 30 and would rise to a maximum of $4,000 for
people 60 and older.
Even with those credits, Democrats
say, many people would find insurance unaffordable. But Republicans would allow
insurers to sell a leaner, less expensive package of benefits and would allow
people to use the tax credits for insurance policies covering only catastrophic
costs.
While Republicans have argued over how to proceed, Mr.
Trump has expressed only vague goals for how to repeal the Affordable Care Act
and improve the nationfs health care system. On Capitol Hill, lawmakers and
their aides are waiting to see whether he uses his platform, Twitter account and
all, to press reluctant Republicans to get behind the House plan.
The new version of the House Republican bill makes several
changes to earlier drafts of the legislation.
It drops a proposal to require employees with high-cost
employer-sponsored health insurance to pay income and payroll taxes on some of
the value of that coverage. In addition, it would delay a provision of the
Affordable Care Act that imposed an excise tax on high-cost insurance plans
provided by employers to workers.
Congress had already delayed this
gCadillac taxh — despised by employers and labor unions alike — by two years, to
2020. The new legislation would suspend the tax from 2020 through
2024.
House Republicans would offer tax credits to help people
buy insurance if they did not have coverage available from an employer or a
government program. Under earlier versions of the bill, the tax credits
increased with a personfs age, but would not have been tied to income. Backbench
Republicans said the government should not be providing financial assistance to
people with high incomes.
Accordingly, under the new version
of the bill, the tax credits would be reduced and eventually phased
out.