Furious Horse-Trading Over the American Health Care Act as House Leaders Try To Placate GOP Factions

The House is scheduled to vote on the American Health Care Act (AHCA) this week, but moderate and conservative members of the GOP continue to clash over just what the bill should contain, according to the Wall Street Journal. President Donald Trump and Republican lawmakers promised to repeal and replace Obamacare, but now the question is just how far they can or should go. Some elements of the ACA remain popular, such as the expansion of Medicaid and the fact that millions more Americans now have insurance thanks to Obamacare.  

“With a vote in the full House scheduled for Thursday, GOP leaders are trying to draw enough support from one group without alienating the other,” WSJ reports. Larry Levitt, a senior vice president at Kaiser Family Foundation, tells the newspaper that “disrupting the status quo in health care is always very hard, and the ACA has become the status quo.”

Conservative GOP House members say roll back the Medicaid expansion and many of the coverage mandates of the ACA, and then let the marketplace do its thing. “They believe more competition among insurers and rules allowing less-comprehensive policies would drive down prices and make coverage more accessible,” the WSJ reports. Conservatives believe that if people are given more choice, they would be better able to choose a plan that best meets their needs and budgets.

Under the ACA, insurers who covered many of the less healthy beneficiaries are eligible for government subsidies to help defray costs. Republican Sen. Rand Paul thinks that any effort to continue such subsidies makes the AHCA Obamacare lite. “We’re talking like Democrats and saying we want to give more subsidies to pay for insurance,” he said.

Moderate Republicans look at how the ACA drove the uninsurance rate down to 11% by late last year. In the third quarter of 2013, that figure was 18%. “Now, a party that has historically railed against social welfare is talking about expanding coverage, in part by offering tax credits to buy insurance, and about retaining protections for people with pre-existing conditions—provisions now part of the federal framework due to the ACA,” the WSJ reports.

Moderate Republicans are also spooked by a report by the Congressional Budget Office that estimates that replacing the ACA with the AHCA would mean that 24 million more people would lack coverage by 2026 than would if the ACA had stayed in place.

GOP House leaders last night announced some changes to the AHCA that they hope will somehow bring the factions together. They include adding tax credits that would help people 50 to 64 buy health insurance, repealing most of the ACA’s taxes starting this year while a tax on so-called Cadillac plans, which offer generous employer sponsored benefits, would begin in 2026, rather than 2025.

Starting in October, Medicaid expansion would also include some work requirements for people who are not elderly, pregnant, or disabled.

And then there’s this: “The original proposal would transition Medicaid starting in 2020 into a system that provides a set amount of funding to states each year,” reports the WSJ. “Under the proposed change, states would have the choice of getting that set amount—known as a block grant—or capped funding based on the number of enrollees, which is known as per-capita funding. Both funding options would result in less federal money for states, but block grants give states more flexibility in how they implement Medicaid. The changes wouldn’t alter the time table for phasing out federal funding for Medicaid expansion, as some conservatives have demanded. That phase-out would begin at the start of 2020.”

Source: Wall Street Journal