Sun Sentinel Palm Beach Edition
House Republicans unveil replacement for Obamacare
Members of both parties are critical of proposal’s details
Substitute for Affordable Care Act would cut federal aid for states to expand Medicaid, restructure system of tax subsidies and end coverage mandate.
WASHINGTON — House Republicans released a long-awaited Obamacare replacement Monday that would dismantle the health care law’s extensive system for expanding health insurance coverage to millions of Americans.
The legislation, the first such bill that House Republican leaders have produced, would eliminate hundreds of billions of dollars of federal aid that has allowed states to expand their Medicaid programs to millions of previously uninsured poor people.
And the bill — titled the American Health Care Act — would restructure a system of tax subsidies that have helped millions of other working Americans who don’t get coverage through an employer to buy health plans.
In all, the plan would likely take away health coverage from several million Americans and raise costs for many more, especially low-income people and the middle-aged. But it would immediately end the requirement that all Americans have insurance, which has been highly unpopular, especially with Republicans, reduce federal authority over the health care system and provide a huge tax cut to upper-income families.
The plan’s impact on the federal deficit is unclear because House Republicans did not release a cost estimate for the proposal.
The bill, the first step in what could be a long and arduous legislative effort to fulfill a key Republican campaign promise, includes several provisions that appeal to conservatives. In addition to doing away with taxes created by the Affordable Care Act and the mandate that Americans have health insurance or pay a penalty, it would ban federal funding for Planned Parenthood and any other medical institutions that provide abortion services, another longtime GOP promise. While it would continue to provide aid to help people buy health plans, it would prohibit Americans from using those subsidies to buy health insurance that covers abortions.
Despite those provisions, the bill faces opposition from many conservatives saying it does not go far enough in uprooting the current law.
The bill also faces attack from some Senate Republicans who are concerned about any plan that eliminates existing Medicaid coverage.
The critiques from both left and right underscore the difficulty the GOP leadership faces in pushing the bill, despite the Republican majorities in both the House and Senate.
Critically, House Republicans did not release any analysis of its impact on insurance coverage.
Those analyses, which are expected to show that millions will lose coverage, could be political bombshells for the GOP. The current law is credited with extending coverage to more than 20 million previously uninsured Americans and driving the nation’s uninsured rate to the lowest levels ever recorded.
Senior House Republicans billed the legislation, which two House committees will start debating Wednesday, as the fulfillment of their seven-year pledge to repeal and replace the Affordable Care Act.
“It is Obamacare gone, because we repeal all those taxes, those mandates, those subsidies. There’s nothing left there,” House Ways and Means Committee Chairman Kevin Brady, R-Texas, one of the lead authors, told Fox News.
But a tweet from Sen. Rand Paul, R-Ky., provided evidence of the opposition from the party’s right wing.
“This sure looks like Obamacare Lite!” wrote Paul, who is leading the conservative opposition with Sen. Ted Cruz, R-Texas, and Sen. Mike Lee, R-Utah, and the House Freedom Caucus.
Congressional Democrats and other defenders of the current health care law charged that the GOP bill would strip away vital health protections.
“Trumpcare doesn’t replace the Affordable Care Act, it forces millions of Americans to pay more for less care,” Senate Minority Leader Chuck Schumer said.
With a few notable exceptions, the legislation released Monday reflects health care plans that House Republicans have been working on for years but have never put into legislative language.
Starting in 2020, the bills would phase out hundreds of billions of dollars in federal aid that has allowed 31 states to expand their Medicaid programs, a key pillar of Obamacare.
After 2020, states could continue to provide expanded coverage, but they would have to pick up substantially more of the cost, a disincentive that would likely force many states to scrap the expanded safety net.
Equally important, the House bill would dramatically change federal support for Medicaid, effectively capping future aid to states.
The House GOP plan would also restructure insurance marketplaces created through Obamacare for Americans who don’t get health benefits at work.
Though the legislation prohibits insurers from turning away sick people, insurers would no longer be required to offer health plans that meet the same coverage standards, another protection in Obamacare. That could allow sale of more catastrophic health insurance plans that impose higher deductibles on consumers.