Changes to House health bill fore­seen

As key vote ap­proaches, Ryan says more can be done for older Amer­i­cans

The Washington Post - - POLITICS & THE NATION - BY MIKE DEBONIS Amy Goldstein con­trib­uted to this re­port.

The Repub­li­can health-care plan mov­ing rapidly to­ward a cru­cial House vote this week is likely to be changed to give older Amer­i­cans more as­sis­tance to buy in­sur­ance, House Speaker Paul D. Ryan said Sun­day.

“We think that we should be of­fer­ing even more as­sis­tance than what the bill cur­rently does,” Ryan (R-Wis.) said in a “Fox News Sun­day” in­ter­view, in which he con­firmed that House lead­ers are eyeing a Thurs­day vote on its pas­sage.

Mean­while, a key con­ser­va­tive sen­a­tor said White House of­fi­cials were con­tin­u­ing to ne­go­ti­ate through the week­end on even more dra­matic re­vi­sions to the bill in hopes of win­ning over hard-lin­ers who have threat­ened to tank the leg­is­la­tion.

Sen. Ted Cruz (R-Tex.) said he and two other con­ser­va­tive lead­ers — Sen. Mike Lee (R-Utah) and Rep. Mark Mead­ows (R-N.C.), chair­man of the House Free­dom Cau­cus — met at Pres­i­dent Trump’s Mar-a-Lago re­sort in Florida in an at­tempt “to fix this bill.”

“I can­not vote for any bill that keeps pre­mi­ums ris­ing,” Cruz said, echo­ing the con­cerns of other hard-line law­mak­ers who want the leg­is­la­tion to undo more of the Af­ford­able Care Act’s in­sur­ance man­dates. “Pres­i­dent Trump said this is one big, fat ne­go­ti­a­tion.

“Here is the cen­tral prize: If we lower pre­mi­ums, and hope­fully lower them a lot, that is a vic­tory for the Amer­i­can peo­ple.”

“It’s a fine nee­dle that needs to be threaded, no doubt about it,” said Health and Hu­man Ser­vices Sec­re­tary Tom Price, speak­ing about the ne­go­ti­a­tions Sun­day on ABC’s “This Week.”

Ryan’s dec­la­ra­tion that more would be done to help older Amer­i­cans came af­ter a third House mod­er­ate said Satur­day that he could not sup­port the bill “in its cur­rent form.”

Rep. Brian Fitz­patrick (R-Pa.), who rep­re­sents a sub­ur­ban Philadel­phia dis­trict that has been heav­ily tar­geted by Democrats, said in a Face­book post that he was most con­cerned that the leg­is­la­tion would roll back ef­forts to pre­vent and treat opi­oid abuse.

But he said that was one con­cern of many, and law­mak­ers from across the GOP’s ide­o­log­i­cal spec­trum have ex­pressed fears that the Amer­i­can Health Care Act will not drive down prices. Reps. Ileana Ros-Le­hti­nen (RFla.) and Leonard Lance (R-N. J.) have cited that con­cern in an­nounc­ing their op­po­si­tion to the bill, and sev­eral other mod­er­ates re­main un­de­cided.

Those fears were stoked last week by a Con­gres­sional Bud­get Of­fice anal­y­sis that fore­cast a short-term in­crease in pre­mi­ums un­der the GOP law, and while pre­mi­ums are ex­pected to drop by roughly 10 per­cent over a 10-year hori­zon, some older and low-in­come peo­ple would face mas­sive premium hikes.

Those over 50 but not yet 65 — and thus el­i­gi­ble for Medi­care, the fed­eral health pro­gram for se­niors — rep­re­sent a ma­jor is­sue in forg­ing an al­ter­na­tive to the ACA. That age group tends to have more med­i­cal is­sues than younger adults and, thus, higher in­sur­ance costs, and the ACA for­bids in­sur­ers to charge their old­est cus­tomers more than three times their rates for young adults — es­sen­tially hav­ing young adults cross-sub­si­dize the cost of cov­er­age for older ones.

But House Repub­li­cans want to elim­i­nate that fea­ture of the law, and the GOP bill would al­low a 5-to-1 ra­tio as part of an at­tempt to at­tract more of the younger, health­ier cus­tomers whom in­sur­ers want.

In an ex­treme case laid out in the CBO re­port, a 64-year-old earn­ing $26,500 a year would see yearly pre­mi­ums rise from $1,700 un­der the ACA to $14,600 un­der the Repub­li­can plan.

Ryan ques­tioned that anal­y­sis, sug­gest­ing that ad­min­is­tra­tive ac­tions taken by the Trump ad­min­is­tra­tion would fur­ther lower pre­mi­ums and ques­tion­ing whether the ACA would re­main vi­able in a decade. But he ac­knowl­edged that the GOP bill would prob­a­bly have to change.

“We be­lieve we should have even more as­sis­tance, and that’s one of the things we’re look­ing at for that per­son in the 50s and 60s be­cause they ex­pe­ri­ence higher health-care costs,” he said.

The GOP bill as writ­ten of­fers a dif­fer­ent type of tax credit for Amer­i­cans buy­ing in­sur­ance on their own. It rises by age and is a fixed amount for in­di­vid­u­als with in­comes of up to $75,000 and cou­ples or fam­i­lies up to $150,000. But un­like the ACA’s sub­si­dies, the amount does not vary with in­sur­ance costs in dif­fer­ent geographic ar­eas, and the gov­ern­ment would over­all spend less money on the cred­its than un­der the cur­rent law. That, ac­cord­ing to the CBO es­ti­mate, leads to sub­stan­tial cost sav­ings that — to­gether with cuts to Med­i­caid — al­low the GOP plan to elim­i­nate nearly all of the taxes im­posed un­der the ACA.

Trump won the sup­port of sev­eral con­ser­va­tive House mem­bers on Fri­day when he agreed to make changes to the Med­i­caid por­tion of the bill, in­clud­ing giv­ing states the op­tion of in­sti­tut­ing a work re­quire­ment on childless, able-bod­ied adults who re­ceive the ben­e­fit.

But Sen. Rand Paul (R-Ky.), who has worked closely with the hard-right bloc in the House, said on “This Week” that the bill was still short of a ma­jor­ity.

Paul said mem­bers of the Free­dom Cau­cus “still be­lieve that the con­ser­va­tives in their cau­cus don’t want Oba­macare Lite.”

“I be­lieve that the real ne­go­ti­a­tion be­gins when we stop them,” he said, re­fer­ring to Ryan and House GOP lead­ers. “You have to stop them.”

Paul noted that he passed out notes based on Trump’s book “The Art of the Deal” at a meet­ing he had with Free­dom Cau­cus mem­bers last week: “We need to learn from the mas­ter, and let’s make sure that we in­crease our lever­age by hold­ing the line.”

But Ryan ex­pressed con­fi­dence that the bill would pass the House this week — and then move to the Se­nate, where the leg­is­la­tion is fac­ing even sharper doubts and the GOP ma­jor­ity is much nar­rower. He cited Trump’s hands-on in­volve­ment as a key fac­tor in mov­ing the leg­is­la­tion for­ward.

“We are mak­ing fine-tun­ing im­prove­ments to the bill to re­flect peo­ple’s con­cerns, to re­flect peo­ple’s im­prove­ments,” he said. “The pres­i­dent is bring­ing peo­ple to his ta­ble, and I’m very im­pressed with how the pres­i­dent is help­ing us close this bill, and mak­ing the im­prove­ments that we’ve been mak­ing, get­ting the votes. . . . We are right where we want to be.”

J. SCOTT APPLEWHITE/AS­SO­CI­ATED PRESS

Sen. Ted Cruz (R-Tex.) and other hard-line law­mak­ers want the leg­is­la­tion to undo more of the Af­ford­able Care Act’s in­sur­ance man­dates.

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