New GOP Trumpcare plan exempts Congress from losing key Obamacare protections

The newest version of the Republican health care bill would exempt lawmakers and their families from some of its most unpopular — and life-threatening — provisions.

The bill would allow states to repeal some provisions of the Affordable Care Act, such as protections covering people with pre-existing medical conditions and requiring insurance companies to pay for prescription drugs and mental health treatment.

But a GOP amendment would maintain those protections for members of Congress and their own families, reported Health Affairs Blog.

The amendment proposed by Rep. Tom MacArthur (R-NJ) has helped gain the support of conservative lawmakers who believe that high-risk groups should pay more for coverage to drive down the cost of insurance premiums for others.

But moderate Republicans remain opposed to the current plan, and a Washington Post/ABC News found 70 percent of Americans want protections for pre-existing conditions to apply to all states.
“The best evidence yet that the new GOP repeal plan is a disaster for people’s health care is that the GOP exempted Members of Congress from living under it,” said Leslie Dach, director of the Protect Our Care Campaign.


In Major Defeat for Trump, Push to Repeal Health Law Fails

WASHINGTON — House Republican leaders, facing a revolt among conservatives and moderates in their ranks, pulled legislation to repeal the Affordable Care Act from consideration on the House floor Friday in a major defeat for President Trump on the first legislative showdown of his presidency.

“We’re going to be living with Obamacare for the foreseeable future,” the House speaker, Paul D. Ryan, conceded.

The failure of the Republicans’ three-month blitz to repeal President Barack Obama’s signature domestic achievement exposed deep divisions in the Republican Party that the election of a Republican president could not mask. It cast a long shadow over the ambitious agenda that Mr. Trump and Republican leaders had promised to enact once their party assumed power at both ends of Pennsylvania Avenue.

And it was the biggest defeat of Mr. Trump’s young presidency, which has suffered many. His travel ban has been blocked by the courts. Allegations of questionable ties to the Russian government forced out his national security adviser, Michael T. Flynn. Tensions with key allies such as Germany, Britain and Australia are high, and Mr. Trump’s approval ratings are at historic lows.

Republican leaders were willing to tolerate Mr. Trump’s foibles with the promise that he would sign into law their conservative agenda. The collective defeat of the health care effort could strain that tolerance.

Mr. Trump, in a telephone interview moments after the bill was pulled, tried to put the most flattering light on it. “The best thing that could happen is exactly what happened — watch,” he said.

“Obamacare unfortunately will explode,” Mr. Trump said later. “It’s going to have a very bad year.” At some point, he said, after another round of big premium increases, “Democrats will come to us and say, ‘Look, let’s get together and get a great health care bill or plan that’s really great for the people of our country.’”

Mr. Trump expressed weariness with the effort, though its failure took a fraction of the time that Democrats devoted to enacting the Affordable Care Act in 2009 and 2010. “It’s enough already,” the president said.

A major reason for the bill’s demise was the opposition of members of the conservative House Freedom Caucus, which wanted more aggressive steps to lower insurance costs and to dismantle federal regulation of insurance products.

In a day of high drama, Mr. Ryan rushed to the White House shortly after noon on Friday to tell Mr. Trump he did not have the votes for a repeal bill that had been promised for seven years — since Mr. Obama signed the landmark health care law. During a 3 p.m. phone call, the two men decided to withdraw the bill rather than watch its defeat on the House floor.

Mr. Trump later told journalists in the Oval Office that Republicans were 10 to 15 votes short of what they needed to pass the repeal bill.

The effort to win passage had been relentless, and hardly hidden. Vice President Mike Pence and Tom Price, the health secretary, visited Capitol Hill on Friday for a late appeal to House conservatives, but their pleas fell on deaf ears.

“You can’t pretend and say this is a win for us,” said Representative Mark Walker of North Carolina, the chairman of the conservative Republican Study Committee, who conceded it was a “good moment” for Democrats.

“Probably that champagne that wasn’t popped back in November may be utilized this evening,” Mr. Walker said.

At 3:30 p.m. on Friday, Mr. Ryan called Republicans into a closed-door meeting to deliver the news that the bill would be withdrawn, with no plans to try again. The meeting lasted five minutes. One of the architects of the House bill, Representative Greg Walden, Republican of Oregon and the chairman of the Energy and Commerce Committee, put it bluntly: “This bill’s done.”

“We are going to focus on other issues at this point,” he said.

The Republican bill would have repealed tax penalties for people without health insurance, rolled back federal insurance standards, reduced subsidies for the purchase of private insurance and set new limits on spending for Medicaid, the federal-state program that covers more than 70 million low-income people. The bill would have repealed hundreds of billions of dollars in taxes imposed by the Affordable Care Act and would also have cut off federal funds to Planned Parenthood for one year.

Mr. Ryan had said the bill included “huge conservative wins.” But it never won over conservatives who wanted a more thorough eradication of the Affordable Care Act. Nor did it have the backing of more moderate Republicans who were anxiously aware of the Congressional Budget Office’s assessment that the bill would leave 24 million more Americans without insurance in 2024, compared with the number who would be uninsured under the current law.

The budget office also warned that in the short run, the Republicans’ legislation would drive insurance premiums higher. For older Americans approaching retirement, the cost of insurance could have risen sharply.

With the House’s most hard-line conservatives holding fast against the bill, support for the legislation collapsed Friday after more and more Republicans came out in opposition. They included Representatives Rodney Frelinghuysen of New Jersey, the soft-spoken chairman of the House Appropriations Committee, and Barbara Comstock of Virginia, whose suburban Washington district went for the Democratic presidential nominee, Hillary Clinton, in November.

“Seven years after enactment of Obamacare, I wanted to support legislation that made positive changes to rescue health care in America,” Mr. Frelinghuysen said. “Unfortunately, the legislation before the House today is currently unacceptable as it would place significant new costs and barriers to care on my constituents in New Jersey.”

The bill died after Republican leaders, in a bid for conservative support, agreed to eliminate federal standards for the minimum benefits that must be provided by certain health insurance policies.

“It’s so cartoonishly malicious that I can picture someone twirling their mustache as they drafted it in their secret Capitol lair last night,” said Representative Jim McGovern, Democrat of Massachusetts. “Republicans are killing the requirements that insurance plans cover essential health benefits” such as emergency services, maternity care, mental health care, substance abuse treatment and prescription drugs.

Mr. Trump blamed Democrats for the bill’s defeat, and they proudly accepted responsibility.

“Let’s just, for a moment, breathe a sigh of relief for the American people that the Affordable Care Act was not repealed,” said Representative Nancy Pelosi of California, the House Democratic leader.

Defeat of the bill could be a catalyst if it forces Republicans and Democrats to work together to improve the Affordable Care Act, which members of both parties say needs repair. Democrats have been saying for weeks that they want to work with Republicans on such changes, but first, they said, Republicans must abandon their drive to repeal the law.

House Speaker Paul D. Ryan walked in the Capitol on Friday after a vote on the rules for debating the American Health Care Act, the bill to replace the Affordable Care Act known as Obamacare.CreditGabriella Demczuk for The New York Times

“Obamacare is the law of the land,” Mr. Ryan said. “It’s going to remain the law of the land until it’s replaced.”

Whatever success Mr. Trump had in making business deals, he utterly failed in his first effort at cutting a deal at the pinnacle of power in Washington, Democrats said.

“This is not the art of the deal,” said Representative Lloyd Doggett, Democrat of Texas, alluding to Mr. Trump’s best-selling book. “It is the art of the steal, of taking away insurance coverage from families that really need it to provide tax breaks for those at the very top.”

Rejection of the repeal bill may prompt Republicans to reconsider the political strategy they were planning to use for the next few years.

“We have to do some soul-searching internally to determine whether or not we are even capable of functioning as a governing body,” said Representative Kevin Cramer, Republican of North Dakota. “If ‘no’ is your goal, it’s the easiest goal in the world to reach.”

Representative Robert Pittenger, Republican of North Carolina, offered this advice to hard-line conservatives who helped sink the bill: “Follow the example of Ronald Reagan. He was a master; he built consensus. He would say, ‘I’ll take 80 percent and come back for the other 20 percent later.’”

Failure of the House effort leaves the Affordable Care Act in place, with all the features Republicans detest.

“We tried our hardest,” said Representative Michael C. Burgess of Texas, chairman of the Energy and Commerce subcommittee on health. “There were people who were not interested in solving the problem. They win today.”

“The Freedom Caucus wins,” he added. “They get Obamacare forever.”

Ex-Trump Supporter Who Attended 45 Rallies Says Attempt to Destroy Obamacare Made Him Turn on the President


CNN’s Erin Burnett Out Front on Tuesday profiled a former Donald Trump supporter who attended 45 rallies during the campaign, but no longer supports the president or his agenda.

Kraig Moss shadowed Trump’s campaign rallies during the 2016 election to tell the story of his son, Rob Moss, who died on Jan. 16, 2014 from a heroin/fentanyl overdose at age 24. The grieving father was a staunch Trump supporter, and was encouraged to support then-candidate Trump by his promise to help addicts struggling with addiction. Trump even reached out to Moss personally at a rally, calling him “a great father,” and assuring him, “your son is proud of you.”

“I’m not on the Trump trail anymore, and I’ve lost my heart,” Moss told CNN’s Elizabeth Cohen in an interview, pointing to the president’s support of the American Health Care Act, which would drop an addiction treatment and mental health mandate that covers 1.3 million Americans. Moss told Cohen he believes Rob would still be alive if he had health insurance.

“I believed everything he said,” Moss said. “Now I don’t believe he was true in his word when he was speaking. I think he was looking for votes, to be honest with you.”

“It’s not at all what Mr. Trump promised everybody he was going to provide for us,” he added. “I feel that now—anger, I feel hurt inside.”

Moss has set up a GoFundMe page in honor of his son. He hopes to raise awareness about the dangers of heroin. You can visit that page here.

As Many as 24 Million People Could Lose Their Health Care Coverage If GOP Gets Away with Repealing Obamacare

An astounding 24 million Americans will lose health insurance by 2026 under the House Republican leadership’s proposed Obamacare repeal, according to a Congressional Budget Office report detailing the estimated effects released Monday.

The 24-million figure comes in waves. The first is people who now have insurance under the Affordable Care Act purchased through state or federal insurance exchanges. The second wave is from lower-income people who would lose their coverage through state-administered Medicaid programs.

“In 2018, 14 million more people would be uninsured under the legislation than under current law,” the CBO’s summary said. “Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”

“Later, following additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program, the increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026,” the CBO report continued. “The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment—because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped.”

Taken together, the CBO estimates that the House Republican plan to repeal Obamacare would deprive 24 million people who now have health insurance of that coverage within a decade.

“In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law,” CBO said.

Before Obamacare, over 15 percent of U.S. residents were uninsured. Today, that number is less than 10 percent, the Washington-based Economic Policy Institute said. Obamacare has seen 19.2 million newly insured individuals between 2010 and 2015, including 2.8 million children.

Meanwhile, health insurance costs would rise 15-to-20 percent for many buying coverage on the open market as early as next year, CBO said, because those seeking insurance would be generally sicker as a cohort, meaning their medical costs would be more.

“The legislation would tend to increase average premiums in the nongroup market prior to 2020 and lower average premiums thereafter, relative to projections under current law,” CBO said. “In 2018 and 2019, according to CBO and JCT’s [Joint Committee on Taxation] estimates, average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher than under current law, mainly because the individual mandate penalties would be eliminated, inducing fewer comparatively healthy people to sign up.”

The CBO report also said the House GOP bill would lead to turmoil in insurance markets as a new mix of health plans, coverage options and deductibles emerge. Younger people would mostly be seeing lower costs, but middle-aged and older people would see sizable increases.

“Although average premiums would increase prior to 2020 and decrease starting in 2020, CBO and JCT estimate that changes in premiums relative to those under current law would differ significantly for people of different ages because of a change in age-rating rules,” the report said. “Under the legislation, insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people.”

The political reaction to the CBO report is as swift as it is predictable. Republicans seeking the repeal of Obamacare at any societal cost have been saying for days that CBO’s numbers can’t be trusted—another version of the right’s fact-dismissing alternative universe. Meanwhile, opponents of Obamacare repeal are saying CBO’s analyses are even more harmful than they anticipated.

“The CBO score only confirms what was already clear, that this bill is not an honest attempt at health care reform, it is instead a tax cut for the wealthy at the expense of the health of millions of everyday Americans,” said Patriotic Millionaires, a coalition of progressive business owners whose experience includes providing employee benefits.

“It is obscene to be cutting the taxes of people like me and my husband for any reason right now,” said Molly Munger, coalition member and co-director of Advancement Project, a nationwide civil rights group. “To cut rich old people’s taxes so that you can take health care away from younger low-income families is especially crazy. We should be investing in these younger people—they are our country’s future. Don’t do me this ‘favor,’ GOP.  It’s greedy and wrong at every level.”

“Because I have diabetes, am over 50, and self-employed, I was paying $5,000 a month for family policy that had a $20,000 deductible. Under the ACA, we now pay $1,400,” said Charlie Fink, director of the New Musical Development Foundation, and another coalition member. “We’re fortunate enough to absorb the hit when prices go back to what they were before, but what about the rest of America’s families, more and more of whom are in our position? A $4,000 tax credit will cover less than 10 percent of the increase in their insurance costs. This will crush them.”


Steven Rosenfeld covers national political issues for AlterNet, including America’s democracy and voting rights. He is the author of several books on elections and the co-author of Who Controls Our Schools: How Billionaire-Sponsored Privatization Is Destroying Democracy and the Charter School Industry (AlterNet eBook, 2016).

Power struggle over ObamaCare repeal

Who will blink first?

House Republican leaders are in a standoff with conservatives over the Republican ObamaCare replacement bill rapidly moving to the House floor. Unless one side gives ground, the bill appears unable to pass.

Conservatives have a range of objections, and many of them are vowing to vote against the legislation unless substantial changes are made. Leadership is pushing back, saying that lawmakers will ultimately face a take-it-or-leave-it proposition with the bill.

The objecting conservatives are looking for help from President Trump, who they say is more willing to negotiate the bill than Speaker Paul Ryan(R-Wis.) and the rest of House leadership.

Trump has endorsed the House GOP bill, but conservative House Freedom Caucus Chairman Mark Meadows (R-N.C.) said his conversations with the administration indicate they are “still willing to negotiate in good faith; that has been reaffirmed time after time.”

“President Trump isn’t as committed to one policy approach as the leadership team is,” said conservative Rep. Justin Amash (R-Mich.). “The leadership team seems to be very committed to this particular approach. And I think the White House just wants to get something done that will fulfill the promise the president made to repeal and replace.”

House Republican leaders have started referring to their bill as a “binary choice.”

“At the end of the day, members are going to have to make a choice: Do they want to vote with Nancy Pelosi or do they want to support President Trump to get that bill to his desk?” House Majority Whip Steve Scalise (R-La.) said Thursday on Fox News.

The conservatives say they won’t back down.

Asked about a leadership assumption they will relent and vote for the bill, Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus, told reporters: “That would be a faulty assumption.”

Conservatives say that leadership doesn’t have the votes to pass the bill without them.

“They’re way short of 216,” said Freedom Caucus member Rep. Raul Labrador (R-Idaho), referring to the needed number of votes for a majority. (Vacancies in the House bring down the number from the usual 218.)

The conservative Republican Study Committee is pushing an amendment to the bill that would move up the date for freezing ObamaCare’s Medicaid expansion to 2018, instead of 2020. Leadership worries that change would drive away Senate moderates already concerned about repealing the Medicaid expansion.

“That’d be very difficult to do,” House Majority Leader Kevin McCarthy (R-Calif.) said Friday of the Medicaid change.

Meanwhile, conservative Freedom Caucus members on Friday said their main concern now is that the measure does not do enough to drive down healthcare costs. They want the bill to repeal ObamaCare’s “essential health benefits,” which mandate healthcare services that plans must cover, as well as ObamaCare’s insurance regulations, like the ban on discriminating against people with pre-existing conditions.

Conservatives say that if those requirements were repealed, insurers could offer cheaper plans that cover less. Right now, they say, the GOP bill could actually raise premiums.

“Obviously we’re going to try to make this bill better, where it actually lowers premiums, so at this point, that’s why there’s not 218 votes, or 215 or 216 whatever the magic number is,” Meadows said. “That’s why there’s not enough votes, because at this point, the number one priority, the top priority, you can throw everything away, is driving premiums down. If we don’t do that, we will have failed.”

The problem, though, is that Senate rules do not appear to allow those items to be repealed through the reconciliation process being used that allows Republicans to bypass a Democratic filibuster in the Senate.

The House committees that wrote the GOP bill say they have been in touch with their Senate counterparts and their understanding is that essential health benefits cannot be repealed through reconciliation.

House conservatives, though, are frustrated with the Senate rules and say that if need be, the presiding officer of the Senate should simply overrule the Senate parliamentarian, who rules on what can be included.

That would be a drastic step, though, of which many Senate Republicans are likely to be wary. Firebrand Sen. Ted Cruz (R-Texas) is pushing the same approach as House conservatives.

McCarthy acknowledged that the Senate rule limiting reconciliation, known as the Byrd Rule, is “frustrating,” but called for pushing ahead with the legislation anyway.

“It’s unfortunate that in the House we are being contained with all of our ideas based upon a Senate rule and a Byrd rule,” McCarthy said. “I think that’s a frustrating part, but we know where we are, and we’re not going to sit back because ObamaCare is failing.”

House GOP leadership says that other ideas that won’t pass muster under Senate rules can be passed in a different “phase” or “bucket” of their plan, in separate bills. Some of those bills could even be voted on the same week as the main repeal and replace measure, McCarthy said. The administration will also take actions on its own, leadership emphasizes.

But conservatives say putting measures in separate bills is not good enough, because they would need 60 votes in the Senate to pass, and therefore are likely to never become law.

“I’m more concerned that whatever needs 60 votes won’t get done,” Meadows said. “Bucket 3, that’s an aspirational bucket.”

Meadows said he is putting his faith in Trump to negotiate changes, even if Ryan doesn’t want to.

“Since the president has to sign whatever ultimately becomes law, his willingness to negotiate would certainly carry a lot of weight,” Meadows said.

Obamacare Creators Tell GOP: We Told You So


President Donald Trump said last week that “nobody knew that health care could be so complicated.”

But the aides and advisers who worked on health care for Bill Clinton and Barack Obama — they knew.

“Maybe I should just say karma is a serious thing,” said Neera Tanden, who was a top health official in the Obama administration. “Health care is hard. Governing is hard. And Republicans are now living with the fruits of never putting forward a plan and making promises they can’t keep.”

It’s a strange place to be for the Democratic operatives and elected officials who saw their party devastated in part by Obamacare. And some can’t help but feel a bit of cosmic justice as they watch Republicans, who passed their plan Friday in the House Ways and Means Committee, stuck in a policy quagmire they know all too well.

Jonathan Gruber, an MIT economist who helped design the Affordable Care Act, said health care policy is both extremely complicated and extraordinarily personal.

“It’s healthcare, it should be easy. Everyone goes to the doctor. But it’s super hard,” Gruber said. “As a result, it’s easy to demonize everything.”

He added, “They (Republicans) have spent years trying to demonize Obamacare and say there was something better, but there was nothing better … It’s overall a sad story. I don’t think anybody can feel good about this.”

Related: Who Wins, Who Loses With the GOP Health Care Bill

Clinton strategist James Carville, a veteran of both recent Democratic reform efforts, has a maxim that “the mover on health care loses,” as he told Democratic donors at a January retreat in Florida. “To do something is to lose.”

After years of unpopularity, nearly six-in-10 Americans now say they want to keep Obamacare or make only minor fixes to it. Fewer than four-in-10 call for repealing it or replacing, according to a new Monmouth Poll.

Republicans “now own the American health care system, which is something that they very effectively said that we owned for seven years,” said Ben Wakana, a former spokesperson for Obama’s Department of Health and Human Services.

“As you see this circular firing squad, part of the problem is they don’t have any principles on health care,” he added. “The thing that kept us grounded when things got hard was we had principles. That kept us all on the same team and in the same room.”

“If you look at the big debates about health care starting with Truman, going to Nixon, going to Clinton, going to now, you find that on the surface, the issues look really straightforward because everybody agrees health care is a big mess. But then you peel it open and it’s unbelievably complex,” said Robert Blendon, a Harvard professor who studies the politics of health care. “It starts to break apart the minute you get into the details.”

That’s exactly what happened after House Republicans rolled out their draft bill to repeal and replace Obamacare Monday night. The response swift and largely negative, leaving a plan seven-years-in-the-making in critical condition less than 24 hours after its public debut.

“The Republicans have done what Democrats couldn’t: Brought the popularity of Obamacare to record levels. They made every election a referendum on Obamacare,” said former Rep. Steve Israel, a Democrat.

Israel led House Democrats’ election efforts during the brutal 2010 midterm, when Republicans rode an anti-Obama backlash to gain 63 seats. Now Israel anticipates Democrats will run on, instead of away from, health care.

“You can expect House Democrats to make the midterm election on ‘Ryancare,” he said.

Democrats have already started collecting sympathetic stories from people who credit the ACA with saving their lives.

Related: American Medical Association Comes Out Against GOP bill

And the party’s campaign arms are zeroing in on a handful of provisions in the proposed draft they think are politically toxic: Funding cuts to efforts to fight the opioid epidemic, penalties for Planned Parenthood, and a tax break for insurance company CEOs who make more than $500,000 a year.

The 2018 midterm elections are still a ways off, but Democrats say they intend to put repeal front and center.

“GOP Senate candidates will now have to defend an agenda that protects the wealthy and well-connected at the expense of Americans who actually work for a living,” said Maryland Sen. Chris Van Hollen, who chairs the Democratic Senatorial Campaign Committee. “Regardless of whether it gets a vote, we’ll make sure there is no rock Republican Senate candidates can hide under.”

House Republicans Unveil Plan to Replace Health Law

WASHINGTON — House Republicans unveiled on Monday their long-awaited plan to repeal and replace the Affordable Care Act, scrapping the mandate for most Americans to have health insurance in favor of a new system of tax credits to induce people to buy insurance on the open market.

The bill sets the stage for a bitter debate over the possible dismantling of the most significant health care law in a half-century. In its place would be a health law that would be far more oriented to the free market and would make far-reaching changes to a vast part of the American economy.

The House Republican bill would roll back the expansion of Medicaid that has provided coverage to more than 10 million people in 31 states, effective in January 2020. The bill would effectively scrap the Affordable Care Act’s unpopular “individual mandate,” eliminating tax penalties for people who go without health insurance. The requirement for larger employers to offer coverage to their full-time employees would also be eliminated.

People who let their insurance coverage lapse, however, would face a significant penalty. Insurers could increase their premiums by 30 percent, and in that sense, Republicans would replace a penalty for not having insurance with a new penalty for allowing insurance to lapse.

House Republican leaders intend to keep three of the Affordable Care Act’s most popular provisions: the prohibition on barring insurance for pre-existing conditions, the cap on lifetime coverage and the rule allowing young people to remain on their parents’ health plans until age 26.

Republicans hope to undo other major parts of President Barack Obama’s signature domestic achievement, including income-based tax credits that help millions of Americans buy insurance, taxes on people with high incomes and the penalty for people who do not have health coverage.

Medicaid recipients’ open-ended entitlement to health care would be replaced by a per-person allotment to the states. And people with pre-existing medical conditions would face new uncertainties in a more deregulated insurance market.

The bill would also cut off federal funds to Planned Parenthood clinics through Medicaid and other government programs for one year.

“Obamacare is a sinking ship, and the legislation introduced today will rescue people from the mistakes of the past,” said Representative Kevin McCarthy of California, the majority leader.

Democrats denounced the effort as a cruel attempt to strip Americans of their health care.

“Republicans will force tens of millions of families to pay more for worse coverage — and push millions of Americans off of health coverage entirely,” said Representative Nancy Pelosi of California, the Democratic leader.

Two House committees — Ways and Means and Energy and Commerce — plan to take up the legislation on Wednesday. House Republicans hope the committees will approve the measure this week, clearing the way for the full House to act on it before a spring break scheduled to begin on April 7. The outlook in the Senate is less clear. Democrats want to preserve the Affordable Care Act, and a handful of Republican senators have expressed serious concerns about the House bill.

Under the House Republican plan, the income-based tax credits provided under the Affordable Care Act would be replaced with credits that would rise with age because health care becomes more expensive as people grow older. In a late change, the plan reduces the tax credits for individuals with annual incomes over $75,000 and married couples with incomes over $150,000.

Republicans did not offer any estimate of how much their plan would cost, or how many people would gain or lose insurance. The two House committees plan to vote on the legislation without having estimates of its cost from the Congressional Budget Office, the official scorekeeper on Capitol Hill.

But they did get the support from President Trump that they badly need to win House passage.

“Obamacare has proven to be a disaster with fewer options, inferior care and skyrocketing costs that are crushing small business and families across America,” said the White House press secretary, Sean Spicer. “Today marks an important step toward restoring health care choices and affordability back to the American people.”

The release of the legislation is a step toward fulfilling a campaign pledge — repeal and replace — that has animated Republicans since the Affordable Care Act passed in 2010. But it is far from certain Republican lawmakers will be able to get on the same page and repeal the health measure.

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 the House, Republican leaders will have to contend with conservative members who have already been vocal about their misgivings about the legislation being drawn up. “Obamacare 2.0,” Representative Justin Amash, Republican of Michigan, posted on Twitter on Monday.

Representative Mark Meadows, Republican of North Carolina and the chairman of the conservative House Freedom Caucus, also offered a warning on Monday, joining with Mr. Paul to urge that Republican leaders pursue a “clean repeal” of the health care law. Even the new approach they view as a big government program.

“Conservatives don’t want new taxes, new entitlements and an ‘ObamaCare Lite’ bill,” they wrote on the website of Fox News. “If leadership insists on replacing ObamaCare with ObamaCare-lite, no repeal will pass.”

The move to strip Planned Parenthood of funding and the plan’s provisions to reverse tax increases on the high-income taxpayers will also expose Republicans in more moderate districts to Democratic attacks.

The bill would provide each state with a fixed allotment of federal money for each person on Medicaid, the federal-state program for more than 70 million low-income people. The federal government would pay different amounts for different categories of beneficiaries, including children, older Americans and people with disabilities.

The bill would also repeal subsidies that the government provides under the Affordable Care Act to help low-income people pay deductibles and other out-of-pocket costs for insurance purchased through the public marketplaces. Eliminating these subsidies would cause turmoil in insurance markets, insurers and consumer advocates say.

However, the House Republicans would provide states with $100 billion over nine years, which states could use to help people pay for health care and insurance.

The tax credits proposed by House Republicans would start at $2,000 a year for people under 30 and would rise to a maximum of $4,000 for people 60 and older.

Even with those credits, Democrats say, many people would find insurance unaffordable. But Republicans would allow insurers to sell a leaner, less expensive package of benefits and would allow people to use the tax credits for insurance policies covering only catastrophic costs.

While Republicans have argued over how to proceed, Mr. Trump has expressed only vague goals for how to repeal the Affordable Care Act and improve the nation’s health care system. On Capitol Hill, lawmakers and their aides are waiting to see whether he uses his platform, Twitter account and all, to press reluctant Republicans to get behind the House plan.

The new version of the House Republican bill makes several changes to earlier drafts of the legislation.

It drops a proposal to require employees with high-cost employer-sponsored health insurance to pay income and payroll taxes on some of the value of that coverage. In addition, it would delay a provision of the Affordable Care Act that imposed an excise tax on high-cost insurance plans provided by employers to workers.

Congress had already delayed this “Cadillac tax” — despised by employers and labor unions alike — by two years, to 2020. The new legislation would suspend the tax from 2020 through 2024.

House Republicans would offer tax credits to help people buy insurance if they did not have coverage available from an employer or a government program. Under earlier versions of the bill, the tax credits increased with a person’s age, but would not have been tied to income. Backbench Republicans said the government should not be providing financial assistance to people with high incomes.

Accordingly, under the new version of the bill, the tax credits would be reduced and eventually phased out.

Republicans have long talk about replacing Obamacare, but no bill yet

Washington (CNN)Congressional Republicans insist they are moving forward on their campaign pledge to repeal and replace Obamacare, but internal divisions over key components mean they will head home for a week-long recess with few details on how they will overhaul the nation’s health care system.

Republicans huddled in the basement of the Capitol for a closed-door meeting Thursday to hear presentations from the two committee leaders leading the effort — Oregon Rep. Greg Walden and Texas Rep. Kevin Brady — who outlined plans to set up tax credits and restructuring how states will administer Medicaid programs that provide coverage for millions.
Members coming out of the meeting continued to stress they were unified on their goal and campaign promise to do away with the Affordable Care Act, but no draft language was was handed out. Most members described a more robust discussion of the House GOP’s “Better Way” health care proposal that they campaigned on in 2016.
“This is a complex issue, one of the members said ‘hey you’ve got to keep this simple.’ You can’t keep this simple. When you are talking about health care and rolling back 2,600 pages of the Affordable Care Act this is going to take some complexity,” Republican Rep. Mark Walker, the head of a group of fiscal conservatives, said after the meeting.
Many conservatives, despite the lack of details, said they are confident that there will be a vote in the first quarter of the year — a goal that House Speaker Paul Ryan has set.
But other members said their new target for moving legislation from committees to the House floor was sometime in mid-April.
In recent weeks, town halls in member’s districts have erupted with angry pushback from voters who are uneasy about the Republicans’ plans to transform the health care system.
At Thursday’s meeting, there was a PowerPoint presentation and members were supposed to get paper versions to bring home, but they weren’t ready in time for the meeting. Instead leaders promised to give each member packets with information so they will be armed with some more answers for voters.
A PowerPoint distributed after the meeting included quotes from Americans who had been negatively affected by the Affordable Care Act and included maps of just how much premiums had gone up in individual states and how few options there were in some places. The slide show included a briefing of the three-part plan to give regulatory relief through administrative action, repeal and replace using reconciliation and then move forward with additional legislation.
Michigan Rep. Bill Huizenga told reporters he wasn’t worried they still hasn’t seen a bill from leaders yet, noting that the Democrats’ efforts to design Obamacare took 14 months.
“We knew we haven’t gotten into this overnight,” Huizenga said. “We are not going to get out of it overnight.”
The official cost estimate of the GOP proposal is still a work in progress by the Congressional Budget Office. Members are awaiting the results.
“If it comes back and it’s out of the roof then it might take some more time to figure out how to pay for this,” Walker admitted.
Missouri GOP Rep. Ann Wagner downplayed the fact that leaders didn’t unveil actual legislation, telling reporters “I think we’ve got the outline of things that will be a part of a bill and part of a reconciliation package going along. We have had this in place for some time, and now we’re getting down to some of the very specifics.”

Trump’s man aims to reassure GOP

Newly installed Health and Human Services Secretary Tom Price, who recently resigned his House seat, attended the meeting and pledged “the president is all-in on this.”
But GOP leaders are concerned that the window for action is tight and they are scrambling to corral members around a proposal. The more time they take the more that counter-pressures from the right and left — to speed up or slow down the process — are making their job more difficult. They are using a budget procedure known as reconciliation to repeal major planks of the law and begin the process of replacing it. This process allows them to pass the measure with a simple majority in the Senate. But they want to use a similar strategy for tax reform so they are mindful of the need to get bill moving soon so they can tackle other issues this spring.
Price discussed the need to stick with the timeline the leaders set out. “Let’s not miss this opportunity. Let’s go shoulder to shoulder, arm to arm,” he said.
But multiple members from across the ideological spectrum stressed that a lot of decisions still hadn’t been made on key issues.
“So there’s obviously unanswered questions and — no shocker here — we have differences of opinion even within our conference,” Huizenga told reporters.

Future of Obamacare taxes, Medicaid programs

Committee leaders walked through several policy issues they are working through such as how to design tax credits for those who will be shopping for health care in the new system and how to address how money will flow to states that administer the Medicaid program.
They went over plans for creating high-risk pools and proposals for incentives for broader use of health savings accounts. In the PowerPoint sent out after the meeting, there was a promise to “deliver relief from the Obamacare taxes,” “eliminate the individual and employer mandate penalties,” and “repeal Obamacare spending for the Medicaid expansion and the new open-ended subsidies.”
But in some areas, there was no clear consensus. For example, the details on how states would handle the Medicaid program are still being worked out. Republicans from Medicaid expansion states have been fighting to keep their expansion money and ensure voters back home who were covered under the program could remain on it, but Medicaid has long been a top target for fiscal conservatives looking to make cuts in the budget. There is wide consensus that states need more flexibility in handling their federal Medicaid dollars, but there still are not clear details on whether that flexibility will come through block grants or per capita allotments is still up in the air.
Ways and Means Committee Chairman Brady told reporters that the discussion was also ongoing as to what to do with Obamacare taxes. Conservatives have said the taxes need to be repealed immediately, but others have been arguing that Republicans will need to keep the taxes in place in the short term to fund their own Obamacare replacement.
Rep. Pete Sessions of Texas told reporters that he had no actual budget numbers of how each program- from tax credits to health savings accounts- would be funded, a key factor in whether or not Republicans will be able to rally around the plan.
“They did not overlay the money and that is the big question,” Sessions said. “You cannot pass policy, you have to pass money. It’s about money.”
So far, a leading member of the conservative House Freedom Caucus didn’t sound impressed with what he heard from his leadership.
“So far it just sounds like Obamacare light,” said Idaho Republican Rep. Raul Labrador.

On eve of possible repeal, the good, bad and ugly of Obamacare

The much-maligned Affordable Care Act may well be headed for the public policy scrap heap if the Trump administration has its way.

But the controversial law — funded by a prodigious river of at least $6.7 billion in tax money — has already fundamentally changed the health care industry. It gave free or subsidized health care coverage to nearly a half-million Oregonians. It also drove insurance companies out of business, led to painful insurance rate hikes, generated windfall profits for hospitals and undoubtedly saved lives.

Now, it’s all at risk. The entire country can only wait and watch to see what the Trump administration does

While the debate gears up in Congress, here’s a look at the profound changes wrought by the legislation. The Affordable Care Act in Oregon, by the numbers:


The first and most concrete impact of the Affordable Care Act was a vast expansion of Medicaid, the 52-year-old federal program that provides free health care to the poor.

Nearly a million Oregonians were enrolled in Medicaid in 2016, compared with just over 600,000 in the pre-Obamacare era.

The ranks of the uninsured plummeted from 16 to 5 percent, or about 280,000 Oregonians.

The new law liberalized qualifying standards to 133 percent of the federal poverty line. That’s not much money — $16,394 in annual salary for an individual.

State planners were stunned as the number of eligible Oregonians easily surpassed initial projections of 250,000 and eventually topped out at 438,000. In many Oregon counties, particularly the rural ones, a third of the population qualified.

So what will the Republicans do? Will they kill off the Medicaid expansion along with the rest of the Affordable Care Act?

No way, says Lynne Saxton, director of the Oregon Health Authority. Oregon just signed a waiver extension with the U.S. Centers for Medicare and Medicaid that should lock in the expansion for five years, she said. In exchange, Oregon agreed to continue to restrict the annual rate increase of delivering health care to 3.4 percent.

Saxton said Oregon provides Congress an example of health care reform that has worked.

“We’ve been developing a highly effective new model here with fiscal discipline,” Saxton said.

My crystal ball is, I think they’ll keep the expanded Medicaid population,” said Dr. Bruce Goldberg, an administrator at Oregon Health & Science University and a former state health official. “I hope they don’t want to see millions of people losing coverage. But they’ll decrease the funding or more subtly decrease funding by ignoring inflation. They’ll give states more ability to cut coverage. I think that’ll be really hard for sick people.”

$6.4 billion

Increasing the Medicaid rolls by nearly 60 percent in Oregon didn’t come cheap. The annual bill approached $1 billion in 2014 and surpassed $2.6 billion in 2015 and 2016.

Even before the Affordable Care Act was thrown into flux by the Republicans’ triumph in November, the Medicaid expansion faced significant budget issues. After paying the full freight for the first three years, the feds now expect states to begin contributing. For Oregon, that comes to $350 million over the next two years. With the state facing a sizable budget gap, it remains to be seen how it will come up with money.

Gov. Kate Brown said Friday that health care is “too important to be treated as a political football.” Her proposed $20.8 billion budget contains $55 million to further expand insurance coverage.


Donald Trump’s vow to repeal the Affordable Care Act was political red meat to his conservative base. But during the presidential transition, Americans flocked in record numbers to get health insurance through the new markets created by the legislation.

In Oregon, 155,000 people signed up in 2017, an all-time high. That’s more than double the 68,308 who signed up in the program’s first year of 2014.

This year, as the Jan. 31 enrollment deadline approached, state officials were inundated with thousands of last-minute applicants. When the Trump administration cut off federal money for customer outreach, Oregon kicked in $110,000 to do its own advertising.

“We got 8,000 new people in the last two weeks,” said Patrick Allen, director of the Oregon Department of Consumer and Business Affairs.The bottom line is, we know the system is going to change. But in these times, it’s a good idea to have health insurance.”

Of course, there was an element of coercion here. The Affordable Care Act threatened to levy financial penalties against Americans who didn’t sign up for health insurance — as much as $695 per person, $2,085 per family.

In 2015 alone, 7.5 million paid about $1.5 billion in tax penalties.

While Trump and Congress may save some significant parts of the Affordable Care Act, they almost certainly will eliminate the requirement to buy insurance, industry sources agreed.

“The individual mandate is dead on arrival,” Goldberg said.

But insurance executives and academics questioned whether the system would work without such a requirement. Dave Underriner, regional chief executive officer of Providence Health & Services, said there needs to be some mechanism to motivate people to sign up and stay insured. “Right now, it’s the mandate,” he said.

Nick Bagley, a University of Michigan Law School professor who tracks health policy, said Republicans have been slow to come up with an alternative to Obamacare because they can’t figure out how to make a system work without the individual mandate.

“It takes a carrot and stick for the market to work,” Bagley said. “And the Republicans hate the the stick. They really are stuck.”

74 percent

To many Americans who didn’t qualify for Medicaid, the Affordable Care Act has felt like a lie.

Insurers struggling to make money in the new market have repeatedly socked their customers with double-digit rate increases. People caught between premiums they can’t afford and tax penalties if they don’t buy insurance were understandably resentful.

Oregonians participating in the new individual market saw their rates climb an average of 27 percent in 2016. That’s on the heels of an average 23 percent jump in the prior year.

Some Oregonians got hit much harder. Jon and Mary Gill, 55-year-old Hermiston residents who own and operate a pool and spa store, got word last fall that their insurance rates would increase 74 percent.

Nevertheless, Moda Health, their Portland-based insurance company, raised their rates from $846 to $1,472 a month. “That’s more than double what we pay on our mortgage,” Mary Gill said.

The Gills say they have no significant health issues. Neither had any surgeries or major medical procedures in 2016. They don’t even take any prescription drugs.

For good measure, Moda also upped their deductible to $7,150 each a year.

Mary Gill said she appealed to Moda and the Oregon Health Division but got no satisfaction.

“It’s just hard to swallow when you pay and pay, but then you have to really have to think twice before you go out and get treatment.”

Moda declined comment.

Allen, the top state regulator overseeing the insurance industry, conceded the new individual market has been a difficult place for some consumers.”The population really dissatisfied with the act are the healthier folks who used to be able to get insurance at a price that reflected their good health,” he said. “Now, they are bearing much of the cost of insuring the rest of the folks who couldn’t get health insurance at any price because they were sick and needed to use it.”

$264.4 million

There’s a reason insurers have gotten aggressive on rates; it was either that or go out of business, they argued.

The Affordable Care Act has been a bloodbath for many insurers, particularly those who aggressively pursued customers in the markets newly created by the act. Companies like Moda badly misjudged the new markets and significantly underpriced premiums.

Though it seems obvious now, some companies failed to take into account that many of their new customers had been shut out of the health insurance market because of pre-existing conditions. The Affordable Care Act mandated that insurers accept those customers. When they finally did get coverage, they tended to be heavy users of health care, which took a toll on some insurers’ bottom lines.

Oregon insurers have cumulatively lost $264.4 million since 2014.

Moda, Oregon’s second largest health insurer, suffered a near-death experience. It lost $49.5 million in 2015 and an additional $33.4 million through the first three quarters of 2016. Regulators forced the Portland company into “supervision” — meaning all business decisions had to be cleared by the state — early last year, citing its sustained losses and depleted capital reserves.

Moda escaped the clutches of regulators only after its parent company raised $115 million in fresh capital by selling assets and by borrowing.

At least Moda survived; other companies had to pull out of the state. Two insurance co-ops created by the Affordable Care Act failed altogether, in part because promised federal financial assistance failed to materialize.

In all, about 58,000 Oregonians were forced to find other insurance as their existing coverage disappeared.


The Affordable Care Act let loose a torrent of tax dollars so large that some are predicting a sudden repeal and cutoff of that money could shock the economy into a recession.

In a just-issued report, the Economic Policy Institute predicts Oregon could lose 42,438 jobs if Obamacare is eliminated. The economic hit would be twofold, said Josh Bivens, a co-author of the report. The nearly half-million Oregonians suddenly without free or subsidized coverage would see their buying power vastly reduced. Plus, hospitals and health systems would suffer a serious blow.

Dr. Joe Robertson, president of OHSU, agreed and went a step further. The Affordable Care Act “has been one of the major factors that helped pull this company out of the last Great Recession,” he said. “That fact has been almost completely overlooked.”

OHSU has for years been a state economic powerhouse. But it and just about every large hospital in the state have enjoyed unprecedented boom times as the newly insured powered a rush of new patients and charity care plummeted.

Employment at OHSU has jumped from about 12,000 before Obamacare to around 16,000 today. But Robertson has opted to slow the hiring spree given the uncertainties in Washington.

Bivens said Oregon may be exceptionally vulnerable to an Affordable Care Act recession because it receives an oversized share of the federal booty.

“One thing that really stuck out as I looked at the numbers is that Oregon gets a ton of federal money,” Bivens said. “It gets a billion dollars more a year than Pennsylvania, which is three times larger. Oregon definitely looks like one of the big losers here.”

— Jeff Manning




Repealing Obamacare without a replacement is “reckless” and “irresponsible,” and would leave the country “with more uninsured and uncompensated care than when we started,” writes former President Barack Obama.

In the commentary published Jan. 26 in the New England Journal of Medicine, one week after the inauguration of Donald Trump, Obama makes good on the pledge in his farewell news conference to speak out “where I think our core values may be at stake.

“What the past 8 years have taught us is that health care reform requires an evidence-based, careful approach, driven by what is best for the American people,” Obama writes. “That is why Republicans’ plan to repeal the ACA with no plan to replace and improve it is so reckless.”

He acknowledged that the law needs fixing. In particular, he writes that the “ongoing challenges” include lack of choice in some health insurance markets, high premiums and high drug costs. And he suggests some remedies: “For example, allowing Medicare to negotiate drug prices could both reduce seniors’ spending and give private payers greater leverage,” he writes.

He sharply criticizes Republican plans to repeal now and replace later. “They have yet to introduce that “replacement bill,” hold a hearing on it, or produce a cost analysis — let alone engage in the more than a year of public debate that preceded passage of the ACA….This approach of ‘repeal first and replace later’ is, simply put, irresponsible — and could slowly bleed the health care system that all of us depend on.”

Given the Republicans’ failure to craft a replacement plan, “there might never be a second vote on a plan to replace the ACA if it is repealed,” he writes, harming tens of millions of Americans, he writes.

Policymakers should abide by the physicians’ oath, he concludes: “First, do no harm.