House GOP not ready with ACA replacement
Reform elements laid out, but no final plan formed.
House Republicans left a highly anticipated meeting on health care Thursday with some new details on the options GOP leaders are considering to replace the Affordable Care Act but without the fully formed plan that those leaders and President Donald 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 members and aides in the room, the House leaders laid out elements of a replacement plan — mostly long-standing GOP reform concepts like health savings accounts, tax credits and state high-risk insurance pools for the chronically sick — but did not detail how those elements would fit together or get passed into law.
“It’s sort of a smorgasbord right now,” said Rep. Daniel Webster, R-Fla.
The reform elements presented Thursday are subject to major internal debates among Republicans. Medicaid, for instance, is a flashpoint between conservatives who want to significantly roll back federal spending and members from states that took advantage of the health law’s Medicaid expansion who are wary of reducing coverage.
Another significant division concerns how to structure tax breaks to encourage individuals to buy insurance plans, which under the law are subsidized based on income. House Speaker Paul Ryan and other House leaders favor refundable tax credits, while many conservatives prefer less expansive — and expensive — tax deductions.
Rep. Raul Labrador, R-Idaho, who backs deductions, said of the tax-incentive debate, “There’s no consensus. We had two minutes to discuss it.”
Even some of the committee leaders who are crafting the health care legislation acknowledged after the meeting that plenty remain unresolved about the GOP health care plan.
“We’re talking different options,” said Rep. Patrick J. Tiberi, R-Ohio, chairman of the Ways and Means subcommittee on Health. “We are working together — this is not top-down; this is bottom-up.”
Asked when legislative text would be released, Tiberi said, “To be determined.”
Ryan told reporters Thursday that legislation would be introduced later this month, after lawmakers return from the recess. He cited news this week that major insurer Humana would stop selling individual plans on health law-mandated state marketplaces.
“It is getting worse by the day, and it will keep getting worse unless we act,” he said. “We need to rescue people from this collapsing law, and we need to replace it with a true patient-centered system.”
What was made clear Thursday was that Trump plans to take a hands-off approach toward the health care lawmaking process — at least for now.
That clashes with Trump’s own statements, including his claim shortly before his inauguration that he had a health care plan “very much formulated down to the final strokes” that would be introduced once Price was confirmed.
Price, who served in the House until his confirmation last week and penned an alternative plan, told members that Trump is “all in” on repealing the Obama-era law and replacing it “concurrently.” But he indicated that the House would take the lead in that process and did not endorse specific reform 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, 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 GOP health proposals will cost. Ryan said the Congressional Budget Office and the Joint Committee on Taxation are currently “scoring” the fiscal effect of the various elements.
The release of those fiscal estimates could widen fissures between the conservatives who wish to keep federal spending to a minimum and the rest of the House GOP, which believes spending will be necessary to prevent turmoil in the insurance markets.
“We did learn a lot,” Rep. Pete Sessions, R-Texas, the House Rules Committee chairman, said of the meeting. “They did not overlay the money, and that’s the big question.”
Rep. Kevin Brady, R-Texas, the chairman of the Ways and Means Committee, said he discussed options for individual tax credits, as well as a possible expansion of the existing system of health savings accounts that allow individuals to set aside untaxed income for health care costs.
“We’re really looking at a whole range of options,” he said.
Rep. Greg Walden, R-Ore., presented options to overhaul the Medicaid system, but said no final decisions were made.
Members discussed whether to institute per-person caps on how much money the federal government would put into the Medicaid system or to shift the program to a “block grant” where states receive a lump sum of money to distribute as they see fit.
A third option would be to give states an option of “either-or,” according to several members who attended the meeting.
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.
“I think there’s a road map,” said Rep. Bill Huizenga, R-Mich. “Whether we’re going to be taking a six-lane highway or a fourlane highway, I don’t think that’s been determined yet.”