Following the Trail of the Affordable Care Act Debate: Part 7

U.S. House of Representatives
By Zach Cahill and David White

This past week has been a rollercoaster as the effort to repeal the Affordable Care Act (ACA) continues. We expected a vote on the American Health Care Act (AHCA) Thursday night, but at the time of publication, votes were postponed until Friday afternoon. Up until noon on Thursday, both President Donald Trump and Speaker Paul Ryan expected to hold a vote to repeal parts of the ACA and replace it with the AHCA on Thursday night; however, that vote did not materialize and many obstacles are still to be overcome.

Late Thursday night, the President dispatched his Budget Director Mick Mulvaney to a closed-door meeting of House Republicans. Directing his comments primarily at ultra-conservative Freedom Caucus members, Mulvaney said that negotiations were over and that the House must pass the AHCA or continue with the ACA status quo – a clear political roll of the dice.

As of early Friday morning, a final bill had still not been reported out of the House Rules Committee and real uncertainty still surrounds Capitol Hill.

Quick Recap of Developments

Let’s back up and set the stage for what ended up being a “terrible, horrible, no good, very bad” week for Speaker Ryan, and somewhat for President Trump.

When we left you last week, the Republican leadership was still struggling to rally its own members around the AHCA. Both conservative and moderate Republican House members had expressed concerns about the bill. President Trump waded into the fray on behalf of House leadership seeking to sway conservative lawmakers.

Last Friday, the President invited wary members of the Republican Study Committee to the White House for a meeting that resulted in many members publicly endorsing the AHCA. On Tuesday morning, the President addressed the Republican caucus on the Hill, warning that if they did not follow through on their campaign promise to repeal “Obamacare” there would be consequences in primaries and at the polls.

The AHCA has received criticism from all sides, forcing House Leadership to amend the bill.  That process took the form of a Manager’s Amendment crafted with leadership and passed in the House Rules Committee – the last stop committee before the AHCA could go to the House floor. The amendment was received as primarily a political fix to unify the Republican caucus.

The Manager’s Amendment included updated Medicaid provisions in the AHCA giving states the option to receive a block grant rather than a per capita grant. A block grant provides funding to states based on the total number of enrollees and does not adjust for changes in population. For states that choose a per capita cap, the payment growth rate was increased by 1%. Previously in the AHCA, Medicaid expansion was left open until 12/31/2019, now Medicaid expansion is closed at 12/31/17.

In an effort to appease more moderate members, $85 billion was offered to increase tax credits for people 50-64 who were adversely effected by the tax credit structure of the AHCA. The legislation also accelerates the repeal of about a dozen ACA taxes by a year, and repeals the “Cadillac Tax” in 2025 rather than 2026.  The Amendment also gave states the option to enact work requirements for “able bodied” Medicaid enrollees.

Ongoing Deliberations

The Congressional Budget Office released a score on these changes late Thursday revealing that the amendment had done nothing to reduce the number of uninsured Americans under AHCA – still estimated to increase that number by 24 million – and would only cut the budget deficit by $150 billion over the next decade, rather than the nearly $350 billion projected for the original bill.

Further changes were made late Wednesday night in negotiations between President Trump and the chairman of the ultra-conservative Freedom Caucus, Mark Meadows (R-NC). The ‘agreement in principle’ would remove the Essential Health Benefit requirements now mandated for all insurance plans. In theory, this repeal would lower premiums. This change resulted in harsh reactions form House moderates. Charlie Dent (R-PA) chairman of the centrist Tuesday Group announced Wednesday night that he was now opposed to the legislation because of its negative impacts on coverage, along with nearly a dozen moderate colleagues.

There are still strong factions in the Senate who are either concerned with the coverage implications of the AHCA or do not believe the House bill goes far enough to repeal the ACA. Despite this, Senate Majority Leader Mitch McConnell hopes to “conclude health care” by next week, a shockingly fast turnaround.

Republican leadership has put itself in the position of needing to appease members with opposite demands to pass the AHCA. To this point, concessions in the House have primarily gone the way of the Freedom Caucus. These changes are anathema to moderate Republican Senators concerned about coverage. If the AHCA passes the House today in its current form, it is essentially dead on arrival in the Senate.

As always, we will keep you appraised of the situation as events continue to unfold in Washington.

Following the Trail of the Affordable Care Act Debate: Part 1Part 2Part 3Part 4Part 5, Part 6

Category:
Subcategory:
Author:
Zach Cahill and David White
Article Image:
U.S. House of Representatives
Body:

This past week has been a rollercoaster as the effort to repeal the Affordable Care Act (ACA) continues. We expected a vote on the American Health Care Act (AHCA) Thursday night, but at the time of publication, votes were postponed until Friday afternoon. Up until noon on Thursday, both President Donald Trump and Speaker Paul Ryan expected to hold a vote to repeal parts of the ACA and replace it with the AHCA on Thursday night; however, that vote did not materialize and many obstacles are still to be overcome.

Late Thursday night, the President dispatched his Budget Director Mick Mulvaney to a closed-door meeting of House Republicans. Directing his comments primarily at ultra-conservative Freedom Caucus members, Mulvaney said that negotiations were over and that the House must pass the AHCA or continue with the ACA status quo – a clear political roll of the dice.

As of early Friday morning, a final bill had still not been reported out of the House Rules Committee and real uncertainty still surrounds Capitol Hill.

Quick Recap of Developments

Let’s back up and set the stage for what ended up being a “terrible, horrible, no good, very bad” week for Speaker Ryan, and somewhat for President Trump.

When we left you last week, the Republican leadership was still struggling to rally its own members around the AHCA. Both conservative and moderate Republican House members had expressed concerns about the bill. President Trump waded into the fray on behalf of House leadership seeking to sway conservative lawmakers.

Last Friday, the President invited wary members of the Republican Study Committee to the White House for a meeting that resulted in many members publicly endorsing the AHCA. On Tuesday morning, the President addressed the Republican caucus on the Hill, warning that if they did not follow through on their campaign promise to repeal “Obamacare” there would be consequences in primaries and at the polls.

The AHCA has received criticism from all sides, forcing House Leadership to amend the bill.  That process took the form of a Manager’s Amendment crafted with leadership and passed in the House Rules Committee – the last stop committee before the AHCA could go to the House floor. The amendment was received as primarily a political fix to unify the Republican caucus.

The Manager’s Amendment included updated Medicaid provisions in the AHCA giving states the option to receive a block grant rather than a per capita grant. A block grant provides funding to states based on the total number of enrollees and does not adjust for changes in population. For states that choose a per capita cap, the payment growth rate was increased by 1%. Previously in the AHCA, Medicaid expansion was left open until 12/31/2019, now Medicaid expansion is closed at 12/31/17.

In an effort to appease more moderate members, $85 billion was offered to increase tax credits for people 50-64 who were adversely effected by the tax credit structure of the AHCA. The legislation also accelerates the repeal of about a dozen ACA taxes by a year, and repeals the “Cadillac Tax” in 2025 rather than 2026.  The Amendment also gave states the option to enact work requirements for “able bodied” Medicaid enrollees.

Ongoing Deliberations

The Congressional Budget Office released a score on these changes late Thursday revealing that the amendment had done nothing to reduce the number of uninsured Americans under AHCA – still estimated to increase that number by 24 million – and would only cut the budget deficit by $150 billion over the next decade, rather than the nearly $350 billion projected for the original bill.

Further changes were made late Wednesday night in negotiations between President Trump and the chairman of the ultra-conservative Freedom Caucus, Mark Meadows (R-NC). The ‘agreement in principle’ would remove the Essential Health Benefit requirements now mandated for all insurance plans. In theory, this repeal would lower premiums. This change resulted in harsh reactions form House moderates. Charlie Dent (R-PA) chairman of the centrist Tuesday Group announced Wednesday night that he was now opposed to the legislation because of its negative impacts on coverage, along with nearly a dozen moderate colleagues.

There are still strong factions in the Senate who are either concerned with the coverage implications of the AHCA or do not believe the House bill goes far enough to repeal the ACA. Despite this, Senate Majority Leader Mitch McConnell hopes to “conclude health care” by next week, a shockingly fast turnaround.

Republican leadership has put itself in the position of needing to appease members with opposite demands to pass the AHCA. To this point, concessions in the House have primarily gone the way of the Freedom Caucus. These changes are anathema to moderate Republican Senators concerned about coverage. If the AHCA passes the House today in its current form, it is essentially dead on arrival in the Senate.

As always, we will keep you appraised of the situation as events continue to unfold in Washington.

Following the Trail of the Affordable Care Act Debate: Part 1Part 2Part 3Part 4Part 5, Part 6

Area(s) of Interest: