WASHINGTON (KTVU/AP) Republicans released their much-anticipated proposals to overhaul and replace the Obama administration's Affordable Care Act, saying the legislation introduced in two committees Monday could go to a committee vote as soon as Wednesday.
After the plan was released, President Donald Trump said he was "proud" to support the House GOP health care bill and hopes Congress will pass it very quickly. The president had tweeted earlier Tuesday that the bill House lawmakers unveiled late Monday was "wonderful."
Trump says the existing Obama-era health care law is "collapsing" and will implode if it isn't replaced. He says if that happens, consumers will be begging for help. But conservative groups and lawmakers are opposing the plan, saying it keeps too many elements of the law that became known as "Obamacare."
Trump met at the White House with the group of House lawmakers who are tasked with rounding up votes for legislation. He says the health care plan will ensure access for all Americans.
The fate of the Republicans' 123-page plan is not assured, however, as Democrats and even some Republicans voiced opposition to the legislation.
The Ways and Means Committee bill would eliminate fines imposed on those who opt out of health insurance, expand health savings accounts (HSA) with higher limits, and replace income-based subsidies to help Americans pay premiums with tax credits based on age. The range would be from $2,000 for each person under the age of 30 up to $4,000 for older individuals in their 60's. The tax credits would apply nationwide and would not be adjusted for regional differences in costs.
The Energy and Commerce bill would extend Medicaid expansion subsidies until 2020, but then limit funding to only those Medicaid recipients who are grandfathered in.
It would also change Medicaid funding from open-ended federal financing to a per capita funding based on state enrollment. It would also seek to create a patient and state stability fund of $100 billion for states that do not have expanded Medicaid.
UC Berkeley Labor Center chair Ken Jacobs has studied health care reform for more than a decade. He says the Medicaid funding cuts would hurt the 31 states and the District of Columbia that expanded Medicaid coverage under the ACA.
"It's going to be up to the states to come up with the money and in California we're talking $8 billion dollars to keep this and if not, what's going to happen is we'll have millions of people dropped off of coverage," said Jacobs, who noted that California has as many as 3.7 million residents who gained insurance through expanded Medicaid.
The Republicans' plan does keep two provisions of the Obama health care law. It would continue the coverage requirement for patients with pre-existing conditions and allow dependents up to age 26 to stay on their parents' plans.
Jacobs says if healthy people drop out, insurance costs could rise and the Republican plan might end up meaning more choice for lower quality health insurance plans.
"They also eliminate the rules for what plans have to cover in terms of essential health benefits, so there might be a plan out there that people can buy... but it will be a plan that covers very little," said Jacobs.
In perhaps the Republicans' riskiest political gamble, the plan is expected to cover fewer than the 20 million people insured under Obama's overhaul, including many residents of states carried by President Donald Trump in November's election. Republicans said they were chiefly focused on reducing costs and increasing choice for consumers.
Republicans said they don't have official coverage estimates yet, but aides from both parties and nonpartisan analysts have said they expect those numbers to be lower. Trump has said his goal is "insurance for everybody," and numerous GOP governors and members of Congress have demanded that people not lose coverage.
House Speaker Paul Ryan, R-Wis., said the bill would "drive down costs, encourage competition, and give every American access to quality, affordable health insurance."
"Republicans have decided that affordable health care should be the privilege of the wealthy, not the right of every family in America," said House Minority Leader Nancy Pelosi, D-Calif.
"They don't want folks to see it until the very last minute. just rush it through," said Senate Minority Leader Charles Schumer of New York.
Four House Republicans said they could not support the Medicaid reductions
They complained that an earlier, similar draft "does not provide stability and certainty for individuals and families in Medicaid expansion programs." Signing were Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Alaska's Lisa Murkowski.
At least three Republican senators objected to income based tax credits.
"There is not a consensus. It is very complicated. And we shouldn't rush it. We need to get this right," said Senator Susan Collins, a Maine Republican on the Senate Health Committee.
"It still looks like Obamacare-lite to me," said Sen. Rand Paul, R-Ky., one of three Senate conservatives who have criticized the GOP bill. "It's going to have to be better."
The Republican tax credits, ranging from $2,000 to $14,000 for families, would be refundable, meaning even people with no tax liability would receive payments. Conservatives say that feature creates a new entitlement program the government cannot afford.
Senate Finance Committee Chairman Orrin Hatch, R-Utah, wouldn't rule out changes by his chamber, where moderate Republicans have grumbled that the measure could leave too many voters uncovered.
"We have a right to look it over and see if we like it or don't," Hatch told reporters.
31 states and the District of Columbia expanded Medicaid coverage to 11 million people and accepted beefed-up federal spending for the program. Around half those states have GOP governors, who are largely reluctant to see that spending curtailed.
In another feature that could alienate moderate Republicans, the measure would block for one year federal payments to Planned Parenthood, long opposed by many in the party because it provides abortions. The bill also bars people from receiving tax credits to help pay premiums for plans that provide abortions.
To prod healthier people to stay covered, insurers would be required to boost premiums by 30 percent for consumers who let insurance lapse.
Tax increases on higher-earning people, the insurance industry and others used to finance the Obama overhaul's coverage expansion would be repealed.
In a last-minute change to satisfy conservatives, business and unions, Republicans dropped a plan pushed by Ryan to impose a first-ever tax on the most generous employer-provided health plans. Instead, a similar tax imposed by Obama's law on expensive plans, set to take effect in 2020, would begin in 2025.
Republicans said they'd not received official estimates on the bill from the Congressional Budget Office. That nonpartisan office's projections on price tag and coverage could help win over recalcitrant Republicans or make them even harder to persuade.