The House Republicans finally unveiled an ACA repeal bill on March 6. But they face critics on the right in both the House and Senate who have been clamoring for a bill that’s even more slimmed down.
And, in the Senate, they face a handful of Republicans (not all of whom are moderates, incidentally) from states that have expanded Medicaid – and who want those coverage gains preserved along with the federal funding that pays for the bulk of it.
So the story isn’t over – but conservatives are ratcheting up the pressure to finally repeal the law – a central promise they’ve been making to their voters since passage in 2010. For instance, FreedomWorks is planning a rally in Washington on March 15 to push for repeal.
The Republicans released the text of the bill – known as the American Health Care Act – without a “score” from the Congressional Budget Office. That means we don’t know exactly how much it will cost – or how many people it will cover. Roughly 20 million people are covered under the ACA – maybe a little less given that enrollment fell short of expectations for 2017 after President Donald Trump’s new administration cut back on outreach efforts. (An official enrollment report is due out soon from CMS.)
Here are some of the key provisions of the bill, formally known as a reconciliation bill because it’s part of the budget process. It needs only 51 votes to pass the Senate (possibly including Vice President Mike Pence as a tie breaker if needed) and cannot be filibustered by the Democrats.
Some provisions that either President Trump or Hill Republicans have been talking about – such as caps on medical malpractice awards, or allowing insurance to be sold across state lines – aren’t in this bill because they don’t qualify under the arcane rules of reconciliation or because the two committees taking up this legislation first (House Ways and Means, and House Energy and Commerce) don’t have jurisdiction over certain provisions. Expect to see some of those measures resurface in other legislation in the coming months.
- Abolishes the individual mandate to obtain insurance, and the employer mandate to cover workers. (Technically, it leaves the mandate on the books but eliminates the penalties for noncompliance so, for all intents and purposes, it kills the mandates).
- Rolls back Medicaid expansion and replaces the traditional Medicaid entitlement program which had open-ended funding with a “per capita cap” that significantly scales back the federal financial commitment. People who are getting covered under expansion could remain in the program, as long as they stay in it without interruption. (Expansion eligibility runs through 2019.)
- Has tax credits that are smaller than the subsidies in the ACA (which were also tax credits, but the payments were made to insurers directly). They will be age-based – not income based. They would start to be phased out at $75,000 for individuals and $150,000 for families.
- Abolishes several taxes that financed the ACA including a 3.8 percent investment tax on higher-income people that Democrats had enacted to help finance the health care law, as well as a 0.9 percent surcharge on wages above $250,000.
- Abolishes (in 2018) levies on medical devices, insurance plans and prescription drug makers
- Suspends until 2025 the “Cadillac” tax on expensive employer-sponsored insurance plans. (The GOP dropped an alternative way of limiting tax breaks on employee health benefits.)
- It does not flat out repeal the “essential health benefits” (that would be a problem under the budget rules – though new HHS Secretary Tom Price has some discretion over how to implement the EHB section of the law) but it does scrap the standardized “metal” (silver, bronze etc) tiers meaning lower-cost plans could be sold in the future.
- Defunds Planned Parenthood for a year.
Rather than pre-existing condition protections as in the ACA, it says that people have to maintain continuous coverage or else if they do let coverage lapse and then want to buy it again, they’d face a 30 percent surcharge for a year.
The bill also includes $100 billion for state grants aimed at stabilizing the individual market and addressing the problems created by sicker or lower-income individuals (such as through reinsurance),
Here’s a section by section summary from Energy and Commerce on its section and a similar summary from Ways and Means. Here’s a Wall Street Journal op-ed co-authored by the chairmen of those two House committees.
- The New York Times: The Parts of Obamacare Republicans Will Keep, Change or Discard
- Kaiser Health News: House GOP Health Bill Jettisons Insurance Mandate, Much Of Medicaid Expansion
- CBO: How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums (Jan. 17, 2017)