After weeks of will-they-or-won’t-they tensions, the House finally passed its GOP replacement for the Patient Protection and Affordable Care Act (PPACA) by a vote of 217 to 213. Now the bill moves across the Capitol to the Senate—and the job doesn’t get any easier. With only a two-vote Republican majority and no likely Democratic support, it would take only three GOP “no” votes to sink the bill, according to an article posted on the Kaiser Health News (KHN) website.
Democrats have made clear that they will unanimously oppose the bill. And Republicans in the Senate have their own internal disagreements.
The KHN article lists five of the biggest flashpoints that could make trouble for the bill in the upper chamber.
For the first time, federal funding for low-income people on Medicaid would be limited, resulting in what House Speaker Paul Ryan (R-Wisconsin) described as “sending it back to the states, capping its growth rates.”
That’s a long-time goal for many conservatives—but it’s not a consensus position in the party. Some moderates support the current program, especially for children and people with disabilities. In addition, many GOP governors took the federal government’s offer under the PPACA of near-complete federal funding to expand Medicaid to nondisabled, working-age adults.
2. Increase in the Number of Uninsured People
The initial estimate of the Congressional Budget Office (CBO) that the bill could lead to 24 million more Americans without health insurance within a decade spooked many senators. The final House bill passed without the CBO score being updated.
3. Tax Credits
Even with the $85 billion added to the bill by House GOP leaders to help older people pay for their insurance premiums, many moderates feel the age-based tax credits replacing those in the PPACA are too small, particularly for people in their 50s and early 60s. The CBO estimated that under the original version of the House bill, premiums for a 64-year-old with an income of $26,000 a year could jump from $1,700 currently to more than $14,000.
On the other hand, some conservatives in the Senate—such as Ted Cruz (R-Texas) and Rand Paul (R-Kentucky)—are ideologically opposed to offering any tax credits. They worry that the credits amount to a new entitlement.
4. Planned Parenthood
As Republicans have been vowing for years, the House-passed bill would defund Planned Parenthood, although only for a year. That’s probably because a permanent defunding would actually cost the federal government more money, according to the CBO, because some women who lose access to birth control would become pregnant, have babies, and qualify for Medicaid.
While cutting funding for Planned Parenthood is overwhelmingly popular in the House, a handful of GOP senators have said they are likely to oppose a bill carrying this provision.
5. Procedural Problems
The budget process Republicans are using to avoid a Democratic filibuster in the Senate, called reconciliation, has strict rules that require every piece of the bill to be directly related to the federal budget. It will be up to the Senate parliamentarian, a Republican appointee, to make those determinations.
Some analysts have suggested that the House amendment sought by conservatives to allow states to waive some of the PPACA’s regulations might run afoul of the Senate’s “Byrd Rule,” which limits what can be included in a budget-reconciliation measure.
Another potentially troublesome element of the original House bill would allow insurers to charge older adults five times more in premiums than younger adults—up from a ratio of three-to-one under the PPACA. That provision could be viewed as not directly affecting federal spending, some analysts predict.
Source: Kaiser Health News; May 4, 2017.