Following the Trail of the Affordable Care Act Debate: Part 4

By Zach Cahill and David White

Two House committees — Energy and Commerce, and Ways and Means — plan to begin voting as early as Wednesday, March 8, or next week at the latest, on portions of their closely guarded legislation to repeal and replace the Affordable Care Act (ACA).  While we have seen start dates come and go, Hill sources believe the horses are loading into the gates.  House and Senate Republican leaders want to push the package through the House this month and hope the Senate can consider it by the early April congressional recess.

Tax Credits -- A Dividing Line?

Last week, many conservative members in both the Senate and the House expressed their opposition to a leaked draft repeal bill that relied on tax credits to subsidize health insurance coverage.  Some Republicans oppose any type of refundable tax credit that exceeds what people have paid in income tax, which they denounce as a new entitlement. These factions in the House and Senate are large enough to scuttle repeal efforts. In the latest leaked draft of their healthcare plan, House Republicans propose to cut off premium tax credits for wealthier Americans, and offer refundable premium tax credits starting in 2020 based on age rather than income.  Without more details, it is unclear how effective tax credits would be at providing greater access and affordability in insurance markets.

Medicaid Expansion

Last week‘s National Governors Association meeting highlighted one of the stickiest issues of ACA repeal: Medicaid expansion. Many GOP governors who presided over Medicaid expansion expressed concerns that a repeal bill that removes funding will leave many constituents vulnerable. A group of GOP governors, led by John Kasich of Ohio and Scott Walker of Wisconsin, are reportedly drafting their own repeal/replace plan to address Medicaid expansion and provide states flexibility to administer their own programs.  Healthcare providers are also deeply worried about how Medicaid expansion and restructuring Medicaid financing would affect their ability to care for low-income and disabled patients.

What President Trump Promises

On Tuesday, February 28, President Donald Trump delivered his first address to a joint session of Congress. In the speech he reaffirmed his commitment to repealing and replacing the ACA. Specifically he outlined five principles for healthcare reform:

1. Ensure people with preexisting conditions have access to coverage and a stable transition for those in healthcare exchanges

2. Help Americans purchase coverage with tax credits and expanded health savings accounts

3. Give state governments flexibility with Medicaid spending

4. Implement legal reforms to protect against unnecessary costs and drive down drug prices

5. Allow the purchase of health insurance across state lines

These principles match up with the repeal plans proposed by House leadership. It is significant that the President seemed open to using tax credits, despite opposition to the policy from conservative members. 

For patients with preexisting conditions, it is unclear if ”providing access” to coverage provides restrictions equivalent to ACA’s restrictions prohibiting insurance companies discriminating against people with preexisting conditions. 

Last Wednesday, House Ways and Means Chairman Kevin Brady (R-TX) and House Energy and Commerce Committee Chairman Greg Walden (R-OR) gave a presentation on the House repeal plan to Senate Republican members in the hopes of winning over skeptics. House leadership seems determined to push repeal efforts forward and gamble that Republicans, who have run on repealing the ACA for years, will not vote against a package labeled “Repeal/Replace.”

We will continue to keep you informed as the debate continues.

Following the Trail of the ACA Debate: Part 1, Part 2, and Part 3

Category:
Subcategory:
Author:
Zach Cahill and David White
Article Image:
Body:

Two House committees — Energy and Commerce, and Ways and Means — plan to begin voting as early as Wednesday, March 8, or next week at the latest, on portions of their closely guarded legislation to repeal and replace the Affordable Care Act (ACA).  While we have seen start dates come and go, Hill sources believe the horses are loading into the gates.  House and Senate Republican leaders want to push the package through the House this month and hope the Senate can consider it by the early April congressional recess.

Tax Credits -- A Dividing Line?

Last week, many conservative members in both the Senate and the House expressed their opposition to a leaked draft repeal bill that relied on tax credits to subsidize health insurance coverage.  Some Republicans oppose any type of refundable tax credit that exceeds what people have paid in income tax, which they denounce as a new entitlement. These factions in the House and Senate are large enough to scuttle repeal efforts. In the latest leaked draft of their healthcare plan, House Republicans propose to cut off premium tax credits for wealthier Americans, and offer refundable premium tax credits starting in 2020 based on age rather than income.  Without more details, it is unclear how effective tax credits would be at providing greater access and affordability in insurance markets.

Medicaid Expansion

Last week‘s National Governors Association meeting highlighted one of the stickiest issues of ACA repeal: Medicaid expansion. Many GOP governors who presided over Medicaid expansion expressed concerns that a repeal bill that removes funding will leave many constituents vulnerable. A group of GOP governors, led by John Kasich of Ohio and Scott Walker of Wisconsin, are reportedly drafting their own repeal/replace plan to address Medicaid expansion and provide states flexibility to administer their own programs.  Healthcare providers are also deeply worried about how Medicaid expansion and restructuring Medicaid financing would affect their ability to care for low-income and disabled patients.

What President Trump Promises

On Tuesday, February 28, President Donald Trump delivered his first address to a joint session of Congress. In the speech he reaffirmed his commitment to repealing and replacing the ACA. Specifically he outlined five principles for healthcare reform:

1. Ensure people with preexisting conditions have access to coverage and a stable transition for those in healthcare exchanges

2. Help Americans purchase coverage with tax credits and expanded health savings accounts

3. Give state governments flexibility with Medicaid spending

4. Implement legal reforms to protect against unnecessary costs and drive down drug prices

5. Allow the purchase of health insurance across state lines

These principles match up with the repeal plans proposed by House leadership. It is significant that the President seemed open to using tax credits, despite opposition to the policy from conservative members. 

For patients with preexisting conditions, it is unclear if ”providing access” to coverage provides restrictions equivalent to ACA’s restrictions prohibiting insurance companies discriminating against people with preexisting conditions. 

Last Wednesday, House Ways and Means Chairman Kevin Brady (R-TX) and House Energy and Commerce Committee Chairman Greg Walden (R-OR) gave a presentation on the House repeal plan to Senate Republican members in the hopes of winning over skeptics. House leadership seems determined to push repeal efforts forward and gamble that Republicans, who have run on repealing the ACA for years, will not vote against a package labeled “Repeal/Replace.”

We will continue to keep you informed as the debate continues.

Following the Trail of the ACA Debate: Part 1, Part 2, and Part 3