House Republicans are mounting yet another effort to tear down Obamacare and remake the health care system — but the path to delivering on one of the GOP’s longest-standing priorities remains complicated and fraught with uncertainty.
House GOP leadership is working furiously to rally support for its Obamacare repeal bill amid threats of a government shutdown, rebellion within its ranks and dire warnings about the consequences for the nation’s most vulnerable Americans. The Trump administration and Republican leaders contend they’re drawing closer to a deal. Still, the situation is more fluid than ever. Here’s where things stand on the biggest outstanding questions:
Give it to us straight: Is the House going to vote on Obamacare repeal this week?
The official answer is no — at least not yet. The Republican leaders are working behind the scenes to win over enough lawmakers to get the 216 votes they need. They’re not there, and there’s little expectation that enough holdouts will flip in time for a Friday vote.
“We’re going to go when we have the votes,” Speaker Paul Ryan said this morning. “It takes time to do that.”
Republicans can only absorb 22 defections — and preliminary counts suggest there are more than that number either opposed to the bill or still undecided. Most are moderate Republicans still wary of provisions in the bill that would roll back Obamacare’s expansion of Medicaid and give states new opportunities to opt out of some of the health law’s core provisions.
The bill has changed a lot since it was first introduced. What would the latest version actually do?
The core elements of the GOP’s original American Health Care Act remain intact — the measure would eliminate big parts of Obamacare, such as its requirement that everybody purchase health insurance, and it would replace the law’s subsidies with a new set of tax credits to help pay for coverage. Those credits would be less generous than what’s offered under Obamacare, and the amount people would receive is based on their age.
The legislation also would overhaul Medicaid, rolling back its expanded coverage and capping its federal funding.
Originally, Republicans planned to keep several other major Obamacare provisions intact. But the changes proposed by the new Tom MacArthur amendment would let states apply for waivers to opt out of federal requirements that insurance plans cover a minimum set of benefits, and reopen the door to charging more based on a person’s health status under certain circumstances. States that take advantage of that flexibility would have to set up a high-risk pool or some other program to ensure that people would not be priced out of the market.
Those changes were essential to winning support from conservatives who complained that the original bill didn’t go far enough to repeal Obamacare. But that shift also threatens to alienate moderates, who were already nervous about leaving more people uninsured.
Who are these moderates? And what will it take to get them on board?
Many of the Republican holdouts belong to the Tuesday Group, the caucus of some 50 centrist House members. Their opposition was key to the GOP’s last-minute decision to abandon a planned vote on Obamacare repeal last month, and they’re still standing in the way. The moderates’ objections vary, but they essentially have one concern: That the repeal bill would leave far more people uninsured than there are with Obamacare.
So far, it looks like that concern hasn’t yet been addressed. The latest version of the bill would retain the phase-out of Obamacare’s Medicaid expansion and wouldn’t make the tax credits more generous. On top of that, the new state waivers could result in more people seeing higher premiums and fewer benefits. The AHCA’s proponents disagree, maintaining that the legislation would incentivize states to customize the health care system to residents’ needs. But it’s not clear that the argument has won over many centrists.
Exactly how many more uninsured are we talking about under the AHCA?
That’s not clear, and won’t be without an updated estimate from the nonpartisan Congressional Budget Office. The agency’s evaluation of the original bill predicted that 24 million more people would end up without coverage over a decade, than there are with Obamacare — losses that would come largely as a result of the restructuring of Medicaid.
But the legislation has changed several times since then, and the CBO hasn’t had an opportunity to take a second look. In fact, it may not do so until after the House votes, assuming that Republicans bring the bill to the floor in the next couple of weeks. The CBO told lawmakers’ offices that it won’t have time to fully reevaluate the revised bill, according to Democrats, and Republicans already under pressure to show progress on the bill don’t seem worried about plowing ahead without a new score.