On Monday afternoon, Republican leaders in the U.S. House of Representatives, led by Speaker of the House of Representatives Paul Ryan (R.-Wis.) released their plan to repeal and replace the Affordable Care Act, or ACA, sometimes known as “Obamacare,” scrapping some key provisions of the 2010 law related to tax and regulatory mandates; but they released their plan—which some referred to as an “outline”—without the required scoring for cost by the Congressional Budget Office (CBO), and in the face of immediate opposition from four key Republican senators, whose refusal to endorse the proposal could doom it in Congress’s upper house.
As The New York Times’ article, posted late Monday afternoon, noted, “The bill’s unveiling set the stage for a bitter and consequential debate over the possible dismantling of the most significant health care law in a half-century. Republicans hope to undo major parts of President Barack Obama’s signature domestic achievement, including income-based tax credits that help millions of Americans afford insurance, taxes on people with high incomes and the penalty for people who do not buy health coverage.”
As Thomas Kaplan and Robert Pear wrote in The Times, “Under the Republican plan, the income-based tax credits would be replaced with credits that would rise with age. In a late change, the plan was also expected to include language limiting who is eligible for the tax credits, so that affluent Americans would not receive them.” At the same time, they noted, “On Monday, four Republican senators — Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska — signed a letter saying a House draft that they had reviewed did not adequately protect people in states like theirs that have expanded Medicaid under the Affordable Care Act. Three conservative Republicans in the Senate — Mike Lee of Utah, Rand Paul of Kentucky and Ted Cruz of Texas — had already expressed reservations about the House’s approach. In combination, the conservatives and moderates have more than enough votes to bring it down in the Senate.”
And as Peter Sullivan reported in The Hill, the legislation comes in the form of two bills, which can be read here and here. “The two measures dismantle the core aspects of ObamaCare, including its subsidies to help people buy coverage, its expansion of Medicaid, its taxes and its mandates for people to have insurance,” he wrote. “In its place, Republicans would put in place a new system centered on a tax credit to help people buy insurance. That tax credit would range from $2,000 to $4,000 a year, increasing with someone’s age. That system would provide less financial assistance for low-income and older people than ObamaCare, but it could give more assistance to younger people and those with higher incomes.”
Further, Sullivan wrote, “Democrats warn that between the phasing out of ObamaCare’s Medicaid expansion and the smaller tax credit for poorer people, the 20 million people who gained coverage in recent years will be put at risk. Republicans acknowledge that their plan will cover fewer people, saying unlike ObamaCare, they are not forcing people to buy coverage. They say their system is less intrusive and provides people a tax credit without mandates or a range of tax increases. House committees are expected to vote on the measures this week, with the full House voting on it soon after that,” his report added.
This legislation, which has been introduced in the House Energy and Commerce Committee, is being introduced via the budget reconciliation process. Its content is entirely focused on the health insurance provisions of the ACA, and does not in any way touch on the numerous internal healthcare system reform aspects of the 2010 law.
Healthcare Informatics will continue to update its readers on new developments in this ongoing story, as they occur.