http://www.commonwealthfund.org/publications/blog/2017/apr/amendment-aca-repeal-and-replace-bill

Yesterday, House Republicans released an amendment to the American Health Care Act (AHCA), their proposed repeal and replacement of the Affordable Care Act (ACA). Congressional Budget Office (CBO) projections of its effects on coverage and the federal budget are not yet available.

The amended version of the AHCA is still likely to significantly increase the numbers of uninsured Americans, raise the cost of insurance for many of the nation’s most vulnerable citizens, and, as originally proposed in the AHCA, cut and reconfigure the Medicaid program. The new amendment specifically allows states to weaken consumer protections by, for example, permitting insurers to charge people with preexisting conditions higher premiums.

What the Amendment Leaves in Place

The amended proposed bill does little to change many provisions of the original AHCA including:

• a phase out of the ACA’s Medicaid expansion;
• capped federal payments to states for their Medicaid programs;
• flat premium tax credits for individual market coverage that adjust for age but not income or premiums;
• the option for insurers to charge older people as much as five times what they charge young people;
• replacement of the ACA’s individual mandate penalties with a premium surcharge for those who fail to maintain continuous coverage;
• repeal of taxes that helped fund the ACA’s coverage provisions;
• state funding for reinsurance or other programs to stabilize the individual market.

The CBO estimated in March that the combined effects of these provisions would increase the number of people without health insurance by 24 million by 2026. Older Americans would be particularly hard hit by the bill, experiencing much higher premiums relative to the ACA and the greatest coverage losses.

What the Amendment Changes

The amendment offers states the option to apply for waivers to reduce ACA consumer protections that have enabled people with health problems to buy private health insurance. Beginning in 2019, states could waive the ban on charging people with preexisting conditions higher premiums, as long as states set up special programs to help people with conditions like cancer or heart disease who could no longer afford coverage. States could also change the ACA’s required minimum package of health benefits for health plans sold in the individual and small-group markets.

Despite the fact the federal ban on preexisting condition exclusions would remain under the AHCA, as Tim Jost points out, insurers could reach the same end by not covering services like chemotherapy that sick people need, or by charging very high premiums for individuals with expensive, preexisting problems. In addition, waiving the ACA’s essential benefit requirement could weaken other consumer protections like bans on lifetime and annual benefit limits and caps on out-of-pocket costs.

States that allowed higher premiums for people with health problems would be required to set up programs such as high-risk pools or reinsurance for high claims costs. Or under an AHCA  amendment proposed earlier in the month, states could also participate in an “invisible risk-sharing” program, a hybrid between a high-risk pool and reinsurance for high claims costs. But while reinsurance options might protect insurers from high claims costs, giving them the ability to charge premiums based on health status would result in many people with preexisting conditions facing unaffordable premiums.  As for high-risk pools, prior research has found that such pools operated by states before the ACA were expensive both for states and for people enrolled in them, and covered only a small fraction of the individuals who would have benefited.

States that had these programs in place could also let insurers charge premiums based on health for people who had not maintained continuous coverage in the prior year.

Looking Forward

Setting aside the amended AHCA’s potential effects on the health and health care of Americans, many questions and uncertainties remain about the bill’s timing and fate. First, the rush to introduce and pass it quickly seems likely to run afoul of Congress’ need to pass a spending bill this week that will keep the federal government funded beyond April 28. So it could be weeks before an amended AHCA gets serious consideration in the House. An important benefit of delay would be to give the CBO time to analyze the impact of the amendments.

Second, the fate of the amended AHCA in the Senate remains uncertain. Some possible provisions – affecting essential health benefits, premium increases based on health, and other features – may not withstand scrutiny by the Senate parliamentarian as she evaluates whether they are appropriate parts of a budget reconciliation bill, and thus exempt from filibuster. Furthermore, many moderate Senate Republicans reportedly have concerns about the Medicaid provisions of the AHCA.

Third, the complex legislative maneuvering around the AHCA should not detract attention from the fundamental facts. Health insurance saves lives and protects Americans from crippling medical debt and even bankruptcy. Changes to existing legislation that result in fewer insured Americans will undermine the health and quality of life of millions of people, as well as increase economic inequality in this country.

House passes ObamaCare repeal

 

House Republicans on Thursday passed legislation aimed at repealing and replacing ObamaCare, taking a major step toward a long-held goal and setting in motion an overhaul of the nation’s health system.

The narrow 217-213 vote is a victory for GOP leaders, who faced a tumultuous path to getting the bill to the floor. The measure had to be pulled in March because of a lack of votes, but a series of deals since then brought on board the conservative Freedom Caucus and then wavering moderates.

The bill, known as the American Health Care Act, repeals the core elements of ObamaCare, including its subsidies to help people get coverage, expansion of Medicaid, taxes and mandates for people to get coverage.

In its place, the bill provides a new tax credit aimed at helping people buy insurance, though it would provide less help than ObamaCare to low-income people.

The Congressional Budget Office found that 24 million more people will become uninsured over the next decade because of the bill. While some of that loss is because of people choosing not to get coverage when the mandate is repealed, much of it would come from Medicaid cuts and the smaller tax credit as well.

Republicans brought the measure to a vote without an analysis from the Congressional Budget Office on the updated bill, meaning lawmakers did not have the full nonpartisan analysis of what the bill would do.

In addition, while Republicans have long argued that Democrats rammed through ObamaCare in 2010, the final changes to the Republican bill were only released the night before the vote.

Republicans’ main argument is that ObamaCare is failing and needs to be replaced. They point to insurers pulling out of certain markets, while Democrats counter that uncertainty from Republican efforts to weaken the law are to blame.

“It’s been a winding road to this point but we’re here today to fulfill the promise that we made to the American people,” said Rep. Diane Black (R-Tenn.) who led GOP floor debate on the measure.

“Under ObamaCare, the situation is getting worse every day,” she said. “We can’t wait a moment longer than necessary to provide relief for the American people by repealing and replacing ObamaCare.”

House Democratic Leader Nancy Pelosi (Calif.), meanwhile, called the measure a “very sad, deadly joke.”

Pointing to the hundreds of billions of dollars in tax cuts, she said the bill “will have the biggest transfer of wealth in the history of our country — Robin Hood in reverse.”

The measure has deep cuts to Medicaid, the government healthcare program for low income people, including putting a new cap on payments and ending ObamaCare’s expansion of the program after 2020.

The bill was a tough vote for some electorally vulnerable members of Congress. Many remained publicly undecided until the last moment as leaders furiously whipped lawmakers over the last several days.

Rep. Mike Coffman (R-Colo.), for example, came out as a “no” hours before the vote. He cited the lack of a CBO analysis as well as weakening protections for people with pre-existing conditions.

The key move to bring the Freedom Caucus on board was an amendment that allows states to repeal one of ObamaCare’s key protections for people with pre-existing conditions, known as community rating. If that were repealed in a state, insurers could go back to charging exorbitant premiums to sick people, which could put coverage out of reach for many.

Republicans counter by pointing to money for high risk pools. A last-minute addition of $8 billion more in funding for people with pre-existing conditions was key to winning over several wavering moderates, though many experts doubt whether that will be close to enough funding.

The measure is expected to undergo a major overhaul in the Senate, especially on the Medicaid front, where several Republican senators from states that accepted the expansion are wary of cutting it off.

The path in the Senate is also even tougher, given that Republicans can lose only two votes and still pass the bill.

https://www.usatoday.com/story/news/politics/2017/05/04/watch-live-house-republicans-set-vote-bill-repeal-and-replace-obamacare/101286430/

Republicans will once again try to repeal the Affordable Care Act when the House votes on a highly controversial health care bill Thursday afternoon. Watch the vote live in the player above.

The current House bill would not fully repeal the 2010 Affordable Care Act, but it would kill major elements of that Democratic law. For example, the American Health Care Act would nix the requirement that most Americans purchase insurance, but it would keep in place a provision allowing younger Americans to stay on their parents’ health plans until age 26.

https://www.usatoday.com/story/news/politics/2017/05/04/house-obamacare-repeal-vote/101270118/?utm_campaign=CHL%3A%20Daily%20Edition&utm_source=hs_email&utm_medium=email&utm_content=51533786&_hsenc=p2ANqtz–zD4_xKS_MGJUPRMJ67P040QzEf4VHBDnlwNMmEW4-HuuUnGfcGowlu4qqSQHcRcpBiKTF_nOqfDz_FXV3iyejOnxM2w&_hsmi=51533786

House Republicans will take another crack at repealing Obamacare on Thursday in a high-stakes vote on legislation that would dramatically revamp the health care system and will serve as a major test for the GOP Congress and the Trump administration.

The Republican bill, hotly contested and highly controversial, was the subject of 11th-hour negotiations and last-minute sweeteners, as GOP leaders scrambled for enough votes to push it through the House and send it to the Senate.

“There’s been a lot of drama, a little bit of trauma along the way,” said Rep. Tom Cole of Oklahoma, a member of the House GOP leadership. He said the vote count is “fairly close,” but he expressed confidence the bill would pass.

Cole and other Republicans shrugged off questions Thursday morning about whether they were allowing lawmakers enough time to read the bill, debate it, and understand its impact.

“It’s a false narrative to say that this has been a rushed process,” said Rep. Larry Buschon, R-Ind., who noted that Republicans have been debating and drafting bills to repeal the Affordable Care Act for more than six years.

The current House bill would not fully repeal the 2010 Affordable Care Act, but it would kill major elements of that Democratic law. For example, the American Health Care Act would nix the requirement that most Americans purchase insurance, but it would keep in place a provision allowing younger Americans to stay on their parents’ health plans until age 26.

The Republican proposal would repeal the ACA’s tax credits, which are based on income and the cost of health insurance in their local market, and replace those with less generous tax credits based on age.

The most contentious element centers on how to deal with patients who have pre-existing conditions, such as cancer, asthma, or diabetes. The Affordable Care Act bars insurance companies from discriminating against those with pre-existing conditions. The GOP bill would weaken that protection by allowing states to seek a waiver for insurance companies to charge people with pre-existing conditions higher premiums than other consumers.

In an effort to woo moderate Republicans who feared that would put insurance costs out of reach for many sick patients, GOP leaders and the White House agreed to include an extra $8 billion to help patients with existing health problems — a sum that critics said was far short of what would be needed to cover the expenses of patients with chronic health conditions.

That tweak won over several key holdouts and gave the GOP much-needed momentum for the bill just as the White House ratcheted up pressure for a House vote this week.

“I support the bill with this amendment,” said Rep. Fred Upton, R-Mich., after meeting with President Trump at the White House on Wednesday morning about his proposal to beef up funding to help individuals with pre-existing conditions. Upton is an influential player on health care policy, and he had previously opposed the bill amid concerns it would undermine protections for those with pre-existing conditions.

Another holdout, Rep. Billy Long, R-Mo., also switched from a “no” to a “yes” after meeting with Trump and working with Upton on his amendment. Long said he and Upton “sold” Trump on their amendment and agreed to switch their votes after he committed to support it.

But the measure still faces fierce resistance.

A bevy of patient advocacy groups, including the American Heart Association and the American Cancer Society, strongly opposed the bill despite the tweaks offered by Upton and others. In a letter urging lawmakers to reject the proposal, 10 health organizations said the measure would undermine key patient safeguards, lead to higher out-of-pocket expenses, and jeopardize coverage for millions of Americans.

“This bill is fundamentally harmful to patients,” the letter stated.

As the House opened debate on the issue, Democrats said the measure would unravel consumer protections and put Americans back at the mercy of the insurance industry.

“The Republican health care bill is reckless and heartless,” said Rep. Rosa DeLauro, D-Conn. “It will have threatening consequences for millions of Americans. It will cost lives.”

Republicans strongly defended the bill, noting that under the Affordable Care Act, premiums have skyrocketed and many insurers have withdrawn from the state and federal exchanges, leaving consumers with high costs and scarce options.

“We are saving health care,” Rep. Chris Collins, R-N.Y., said as he and other Republicans left a closed-door GOP meeting on the measure.

With Democrats unified against the measure, GOP leaders can only lose about 22 Republicans and still pass the bill. The proposal has been a tug-of-war between the moderate and conservative factions inside the House Republican Conference during weeks of intense negotiations and embarrassing setbacks.

By the count of various news outlets, about 20 lawmakers said they’d vote “no” as of Wednesday afternoon and about two dozen others remained undecided, but the tallies remained highly fluid as House leaders and President Trump lobbied individual holdouts and won over converts.

As they left their Thursday morning meeting, Republicans expressed confidence they would have enough support to pass the measure, although the vote could be a down-to-the-wire squeaker. Even if the House approves the bill, it faces uncertain prospects in the Senate. Some Senate Republicans are lukewarm about the House bill, and Senate Democrats are fiercely opposed.

“Its chances for survival in the Senate are small,” said the Senate’s top Democrat, Chuck Schumer of New York, on Wednesday.

House to vote Thursday on ObamaCare repeal

The House will vote Thursday on a bill to repeal and replace ObamaCare, a GOP source said.

The announcement sets up a high-stakes vote that is expected to come down to the wire.

The move comes after the bill gained new momentum on Wednesday, after GOP Reps. Fred Upton (Mich.) and Billy Long (Mo.) said they would support the bill after a new amendment from Upton.

Still, no lawmakers other than those two have publicly given their support since the announcement of the new amendment.

“We will be voting on the healthcare bill tomorrow. We have enough votes. It will pass. It’s a good bill,” House Majority Leader Kevin McCarthy (R-Calif.) said after leaving a leadership meeting Wednesday night.

Asked by a reporter about whether the bill would have to be pulled from the floor again for lack of support, McCarthy replied: “Would you have confidence? We’re going to pass it. We’re going to pass it. Let’s be optimistic about life.”

McCarthy cited an insurer pulling out of the ObamaCare exchanges in Iowa Wednesday as a reason the law needs to be quickly repealed.

“That’s why we have to make sure this passes. To save these people from ObamaCare, which continues to collapse.”

The Upton amendment would provide $8 billion over five years to help people with pre-existing conditions afford their premiums in states that are granted a waiver from ObamaCare’s protections.

The House will vote without waiting for a new Congressional Budget Office (CBO) analysis of Upton’s changes or the amendment from Rep. Tom MacArthur (R-N.J.) that won over the House Freedom Caucus. That analysis will eventually provide insight into the bill’s effects on coverage and its cost.

The MacArthur amendment set off moderates’ concerns, because it allows states to waive ObamaCare protections that prevent people from being charged higher premiums based on their health. If those were repealed, insurers could go back to charging exorbitant premiums to sick people, which could put coverage out of reach for many.

Supporters of the amended bill argue high-risk pools could fill the gap, and note that people with pre-existing conditions would still be protected if they had no gaps in coverage.

Many health policy experts, though, said the additional $8 billion from the Upton amendment is not enough to help sick people get coverage.

The liberal Center for American Progress estimated on Tuesday that the high-risk pools are underfunded by $200 billion over 10 years.

Members of the moderate Tuesday Group discussed the changes at a Wednesday meeting that included House Energy and Commerce Chairman Greg Walden (R-Ore.).

Leaving that meeting, no lawmaker said they had changed their position.

Rep. John Faso (R-N.Y.) said he was still undecided and studying the changes. Rep. Adam Kinzinger (R-Ill.) declined to comment when asked if he was still undecided.

The underlying bill has several provisions some moderates object to, such as deep Medicaid cuts. The CBO estimated an earlier version of the overall legislation would result in 24 million more people becoming uninsured over a decade.

Major health groups like the American Medical Association and the American Hospital Association are strongly opposed to the measure, warning of coverage losses and other problems.

According to the Hill’s whip list, there are 20 no votes from the GOP on the latest iteration of the bill. No Democrats are expected to vote for the measure, meaning Republicans can only afford 22 defections.