As the U.S. House of Representative marks up Paul Ryan's American Healthcare Act, the battle between the moderate and conservative factions of the Republican Party continues to mount behind the scenes all while opposition from a variety of advocacy groups is also growing. “This is what good, conservative health-care reform looks like,” House Speaker Paul Ryan said Wednesday. “It is bold and long overdue. And it is us fulfilling our promises.”
Despite the public bickering, Republicans scored a victory early Thursday, pushing a measure through the House Ways and Means Committee repealing tax penalties on people who don’t buy insurance but otherwise progress on the bill has been slow.
As the Wall Street Journal notes, Ryan and House Republicans have to thread a very fine needle on healthcare legislation that appeals to a sufficient number of conservatives to pass the House while not alienating the more moderate factions of the party in the Senate.
House Republican leaders are under pressure to ease passage through the House by making changes that appease conservatives who want a more aggressive repeal of the ACA. Those changes risk further jeopardizing support in the Senate, where centrist Republicans have said they are concerned the proposal will cause too many people to lose coverage, particularly those with low incomes.
Underscoring the Senate’s central role, a group of Republican governors representing states that expanded Medicaid under the existing law have largely given up on lobbying the House and instead are focusing their efforts on the Senate, according to two people familiar with their thinking.
“Yes, I do not think it will be well received in the Senate,’’ Sen. Susan Collins (R., Maine) told Yahoo News. “But I do want to emphasize that it’s still a work in progress. … So, who knows, maybe it’ll eventually get better.’’ She also signaled she would oppose measures in the House bill to end funding for Planned Parenthood.
The GOP proposal topples many central provisions of Obamacare, including a requirement that most Americans buy health coverage or pay a penalty. The plan would end tax credits provided to lower-income people on the ACA’s exchanges and replace them with new tax credits for a broader set of people who don’t get insurance through their work.
The credits would be pegged to age and would phase out for higher-income earners. In many cases, analysts say, the credits would be less generous for older and low-income consumers, and for people in areas with high health costs, than the subsidies offered under current law.
The bill would repeal the majority of the health law’s taxes starting in 2018 and freeze federal funding in 2020 for the 31 states that expanded Medicaid. It would also overhaul and reduce federal funding for Medicaid.
But opposition is mounting from groups representing hospitals, doctors and seniors which are urging House Republican leaders to put the brakes on their plan to overhaul the Affordable Care Act, saying it risks stripping too many people of insurance and in some cases would hurt industry finances.
America’s Essential Hospitals, whose members serve large numbers of uninsured patients, sent a letter on Wednesday to House leaders saying it was ill advised to consider the legislation without an estimate of the costs and coverage implications from the Congressional Budget Office, the independent office that assesses legislation for Congress. Those assessments won’t arrive for several days. The hospital group also said some provisions would hurt patients.
“America’s Essential Hospitals cannot support the legislation to be considered by the committee,” Dr. Bruce Siegel, president and chief executive, said in the letter.
The American Medical Association, a physician group, said in a letter to Congress on Tuesday that it is unable to support the GOP bill because of “the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.”
And a major association of insurers, America’s Health Insurance Plans, warned in a letter that the bill could damage the insurance market and hurt Medicaid enrollees.
Meanwhile, President Trump has promised a full-court press to rally support for RyanCare while reportedly saying that if the House GOP's ObamaCare repeal and replace plan fails to pass, then he'll simply let ObamaCare fail and will blame the Democrats.
"Trump said he will have football stadium events in states where he won by 10-12 points and he is going to dare people to vote against him," a source at the meeting said.
“We’re going to have a full-court press,” Mr. Spicer told reporters. “You will see a lot of travel and a lot of activity by the president and all of the administration.”
Grab your popcorn, this fight should get fun.