GOP leaders amend ACA repeal bill, mostly to the right
March 20, 2017 - Associated Press/Modern HealthcareHouse Republican
leaders have released changes to their healthcare reform bill that seek to
please both conservative and moderate members of their party.
By Harris Meyer - Modern Healthcare
were mostly designed to win over ultra-conservative members of the U.S. House of
Representatives' Freedom Caucus, whose members were threatening to vote against
the American Health Care Act when GOP leaders plan to bring it to the House
But some of the new provisions were aimed at allaying the
concerns of Republicans alarmed by last week's Congressional Budget Office
projections that the bill would make insurance less affordable for people aged
50 to 64 and sharply drive up the uninsured rate in that group.
changes are likely to reduce the federal budget savings produced by the bill,
which the CBO projected at $337 billion over a decade. But House GOP leaders
have signaled that they do not plan to seek an updated CBO score on the revised
bill before the scheduled floor vote Thursday, after the bill is considered by
the House Rules Committee.
manager's amendments, most of which were backed by Republicans on the House
Budget Committee last week, would:
• end most of the ACA's taxes at the
end of this year, one year earlier than in the original bill.
• bar any new
states from expanding Medicaid to low-income adults and receiving enhanced
federal funding for that population.
• establish a work requirement for
Medicaid enrollee adults who aren't disabled, elderly or pregnant; states that
institute a work requirement would receive a 5% extra administrative
• give states the option to receive federal Medicaid funding in the
form of fixed block grants not based on number of enrollees, or to receive it in
the form of per-capita allocations.
• Increase the growth rate of capped
federal payments to the states for elderly and disabled beneficiaries by the
medical component of the consumer price index plus one percentage point; the
growth rate for other beneficiary groups would be the medical component of CPI,
which lags behind actual per-capita Medicaid spending by 0.7 percentage points,
according to the CBO.
• Delay implementation of the ACA's excise tax on
high-value employer health plans for an additional year, from 2025 to 2026.
Penalize New York state for requiring some counties to contribute to Medicaid
funding. Upstate Republicans wavering on supporting the bill had pressed for
this provision – already dubbed the gBuffalo
buyouth -- to reduce property taxes in their counties, but hospitals and
nursing homes had warned it would lead to big Medicaid spending cuts that would
reported that the manager's amendment would establish a reserve fund of at
least $75 billion for tax credits to help Americans between the ages of 50 and
64. The amendment would not actually set up the credits but would instruct the
Senate to do so. The reserve fund is not mentioned in the four-page summary of
The fate of the bill remains shaky in the Senate, where a
number of Republicans have voiced strong concerns about its $880 billion in
Medicaid spending cuts over 10 years and the projected increase in uninsured
Americans by 24 million.
But Joe Antos, a conservative health policy
expert at the American Enterprise Institute, predicted that edgy Republicans in
the House and Senate are likely to come around and back the bill because this
will be the only vehicle for repealing and replacing Obamacare.