House Republicans on Monday unveiled their long-awaited legislation to repeal and replace ObamaCare, with plans to quickly push the measure through committee votes this week.
The two measures dismantle the core aspects of ObamaCare, including its subsidies to help people buy coverage, expansion of Medicaid, taxes and mandates for people to have insurance. The bills also dramatically restructure the Medicaid program overall by capping federal payments.
In its place, Republicans would put a new system centered on a tax credit to help people buy insurance.
House Republicans plan to take up the legislation at a breakneck pace, with two committees — Energy and Commerce and Ways and Means — scheduled to hold votes on Wednesday. A vote in the full House is expected to soon follow, within weeks.
House Ways and Means Committee Chairman Kevin Brady (R-Texas) said Monday on Fox News that he’s confident the legislation will pass with solid Republican support despite recent party infighting over the details.
“We’ve been listening very carefully to our Republican members for months now to make sure we get it right,” he said. “I am confident we are going to pass this.”
Brady noted that many of the elements of the bills have passed the House “a number of times” over the years.
Speaker Paul Ryan (R-Wis.) in a statement claimed that ObamaCare “is rapidly collapsing” and vowed the GOP’s plan — dubbed the American Health Care Act — will “give every American access to quality, affordable health insurance.”
Republicans acknowledge that their plan will cover fewer people, saying that unlike ObamaCare, they are not forcing people to buy coverage through a mandate. They say their system is less intrusive and provides people a tax credit without mandates or a range of tax increases.
But the measures face a rocky path, particularly in the Senate. Four Republican senators earlier Monday objected to an earlier version of the House plan, saying that it fails to protect ObamaCare’s Medicaid expansion.
Even in the House, there are objections. Conservatives in the House Freedom Caucus object that the new tax credit is a “new entitlement.” They have enough votes to kill the legislation, but it remains to be seen whether they will actually vote against a bill that dismantles the core of ObamaCare.
The GOP measure significantly restructures the Medicaid program, which provides coverage for around 70 million poor, disabled and elderly people, to cap federal payments.
The repeal of the Medicaid expansion and ObamaCare’s subsidies would not take effect until 2020, meaning current enrollees could keep their coverage this year.
Republicans would also grandfather in current Medicaid enrollees so that they can stay on the program. But once 2020 arrives, the federal government would no longer provide the extra federal funds that allow for expansion.
That plan has drawn objections from more centrist Republican senators, who want to protect the expansion and are worried about constituents losing coverage and their states losing federal funds.
The legislation would maintain ObamaCare’s protections for people with pre-existing conditions, who could still not be denied coverage by insurers. Instead of ObamaCare’s mandate, the GOP plan would seek to encourage healthy people to sign up by allowing insurers to charge people 30 percent higher premiums if a new enrollee has had a gap in coverage.
The legislation also repeals nearly all of the taxes created by ObamaCare, including the medical device tax and health insurance tax, starting in 2018. The bills scrap a controversial Republican proposal in earlier drafts that would have started taxing some employer-sponsored health insurance.
To ensure that the legislation passes muster under special budgetary rules, it keeps ObamaCare’s “Cadillac tax” on generous plans after 2025. That provision, which could prove controversial, will help ensure that the measure does not add to the federal deficit in that decade.