Critics on the conservative side are calling it “ObamaCare Lite,” while Democrats are vehemently against any repeal bill and see view this as a rollback of health insurance access. The new law would do away with some parts of ObamaCare that were unpopular, yet keep some of the key aspects which have high approval in polling, such as protections for pre-existing conditions.
PRIVATE HEALTH INSURANCE
— Provides tax credits for people purchasing their own health insurance. The subsidies would be keyed primarily to age, rising as people get older. Financial assistance would be phased out for individuals making more than $75,000 and married couples earning more than $150,000. Subsidies could be used to buy any plan approved by a state.
— Eliminates cost-sharing subsidies in Obama’s Affordable Care Act that helped people with modest incomes meet the costs of insurance deductibles and copayments. States, however, would have the option of providing similar assistance with federal financing.
— Greatly expands contributions to health savings accounts, which allow people with high-deductible insurance to cover expenses that their plans don’t pay for.
— Protects people with pre-existing health problems from being denied coverage. However, consumers must maintain continuous coverage — otherwise, they would face a flat 30 percent surcharge on top of their premiums. States could use federal money to create high-risk pools as insurers of last resort.
— Preserves ACA provision that let young adults stay on parental coverage until they turn 26.
— Allows insurers to charge their oldest customers up to 5 times what they charge young adults. The ACA limits that to 3 times.
— Prohibits use of tax credits to purchase any plan that covers elective abortions. Currently if a health plan covers abortions it must collect a separate premium to pay for such procedures.
— Maintains the ACA’s higher federal financing for expanded Medicaid through the end of 2019. After that, states can only continue to receive enhanced federal payments for beneficiaries already covered by the expansion, which has mainly helped low-income adults with no children living at home. But for newly enrolled beneficiaries, the federal government would provide a lower level of financing.
— Overhauls the broader Medicaid program to end its open-ended federal financing. Instead, each state would receive a limited amount based on its enrollment and costs. That federal payment would be increased according to a government measure of medical inflation.
— Denies federal funding for one year to Planned Parenthood, a major provider of women’s health services, including abortion.
PENALTIES & TAXES
— Repeals the ACA’s tax penalties on people who remain uninsured and on larger employers who do not offer coverage. The repeal is retroactive to 2016.
— Repeals the ACA’s taxes on upper-income earners, investors, health insurance plans and medical device manufacturers. Repeals 10 percent sales tax on indoor tanning.
Some of the harshest criticism, so far, has come from the Republican side of the aisle, as the Washington Post reports:
Sen. Rand Paul (R-Ky.), one of at least three conservative senators who opposes the plan to provide income-based tax credits, tweeted: “Still have not seen an official version of the House Obamacare replacement bill, but from media reports this sure looks like Obamacare Lite!”
And four key Republican senators, all from states that opted to expand Medicaid under the ACA, said they would oppose any new plan that would leave millions of Americans uninsured.
“We will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states,” Sens. Rob Portman (Ohio), Shelley Moore Capito (W.Va.), Cory Gardner (Colo.) and Lisa Murkowski (Alaska) wrote in a letter to Senate Majority Leader Mitch McConnell (R-Ky.).
As the Post notes, that could be four GOP Senators who oppose the legislation as it currently stands, leaving Republicans with just 48 votes, a number short of the required 50 vote threshold which would let Vice President Pence break the tie as the 51st GOP vote.
Paul also penned an op-ed with Rep. Mark Meadows outlining what they want to see in an ObamaCare replacement bill:
We call on Congressional leaders to keep their word to the American people, to push a real repeal of ObamaCare, and to do it now. The only way to really do that in a way that ensures passage is to move forward with a “clean” repeal, such as the 2015 repeal bill
Many conservatives have called for Replace bills at the same time as a repeal bill. A free market replacement bill has been introduced in the Senate and a companion bill endorsed by the House Freedom Caucus. Others have their own plans and ideas. The White House will no doubt have some ideas as well.
We should debate all of these replacement ideas on the same day we pass Repeal, but we will have to separate the debate into at least two different bills because there is no consensus with leadership on replacement. While the vast majority of Republicans have come out in favor of the principals of our replacement bill, some in leadership have offered starkly different ideas.
Senate Minority Leader Chuck Schumer coined the new bill “TrumpCare,” and vowed that Democrats in Congress would work tirelessly to oppose this law and any other rollbacks to the Affordable Care Act. Report from The Hill:
Senate Minority Leader Charles Schumer (D-N.Y.) on Monday slammed the GOP’s replacement plans for Obamacare, saying Democrats will work to defeat the bills.
“This bill is a giveaway to the wealthy and insurance companies at the expense of American families, and Senate Democrats will work hard to see that it is defeated,” Schumer said in a statement.
Schumer, dubbing the legislation “Trumpcare,” said the bills would force “Americans to pay more for less care.”
“To make matters worse, this sham of a replacement would rip treatment away from hundreds of thousands of Americans dealing with opioid addiction, breaking the President’s word that he would expand treatment, not cut it,” Schumer said.
Democrats were set to be in opposition no matter the content of this new repeal legislation, that was pre-ordained. They will not be sitting back as the GOP congress, with Trump’s help, works to dismantle one of President Obama’s key legislative victories.
The battle to watch will be on the Republican side where the conservative wing of the party is clashing with the “Ryan wing.” The reality is that any repeal law is going to create another disruption in the insurance market and cause some to lose their plan or their coverage entirely, just like ObamaCare did back in 2009 and 2010. The group of GOP Senators who say they’re opposing the law on the grounds that it will cause disruption might be the biggest hurdle for this to overcome.
President Trump appears to have signed on to this bill according to his twitter feed:
The battlefield is set, time to watch this whole thing unfold over the next few months.