Trump and GOP 'Pull' House Bill to Replace ACA

Disclosures

March 24, 2017

For the second day in a row, House Republican leaders today canceled a scheduled vote on their bill to replace the Affordable Care Act (ACA) because there weren't enough ayes to pass it.

"We just pulled it," the Washington Post quoted President Donald Trump as saying this afternoon.

"It's not clear if another vote will be rescheduled, or if the bill, called the American Health Care Act (AHCA), is history. Trump told reporters at the White House that he will eventually mount another campaign to repeal and replace the ACA, hopefully with Democratic cooperation, after "ObamaCare explodes." He blamed House Democrats for not casting a single vote in favor of the replacement bill.

House Speaker Paul Ryan (R-WI) said at a press conference that he canceled today's vote after recommending that move to Trump and getting his okay.

"We're going to be living with ObamaCare for the foreseeable future," said Ryan. I don't know how long it's going to take to replace this law."

Ryan predicted that the ACA would continue to descend in a death spiral of rising premiums and fewer participating insurers, although Congressional Democrats say that doesn't have to happen if lawmakers simply fix its weaknesses.

The impasse reflects the failure of Trump and Ryan to win over Republican critics of the bill. These critics include members of the staunchly conservative House Freedom Caucus, who consider the AHCA too much like the law that it replaces.

Trump insisted on a House vote today after the cancellation of yesterday's scheduled vote. White House budget director Mick Mulvaney told CNBC that the president was willing to let the ACA remain the law of the land if House Republicans wouldn't pass the latest version of the AHCA.

GOP leadership had added several amendments in an unsuccessful effort to make the bill more palatable to the Freedom Caucus. One change created work requirements for able-bodied adults to receive Medicaid. Another eliminated an ACA provision that all individual and small group plans have certain essential benefits, such as hospitalization, preventive care, and prescription drugs. Instead, states would have the job of defining what care must be covered. The amendment would give states an extra $15 billion over 10 years to bolster coverage of mental health, substance abuse, maternity, and new-born care, all essential benefits under the ACA.

The Freedom Caucus has argued that the ACA's essential-benefits provision drives up cost of coverage, making it unaffordable for many Americans. Congressional Democrats counter that removing this provision will result in stripped-down, albeit less expensive, health plans that leave people high and dry when they need noncovered care.

The amendment to delegate the essential-benefits menu to the states wasn't enough, however, to satisfy the Freedom Caucus. It also wanted to repeal other ACA consumer protections that prevent insurers from denying someone coverage for pre-existing conditions, for example, and allow young adults to stay on their parents' health plan until age 26, according to published reports. Trump and Ryan couldn't go that far.

At the same time, the AHCA and amendments designed to placate the Freedom Caucus drew opposition from some moderate House Republicans, who saw the legislation as more harmful to their constituents than the ACA.

In a nutshell, the AHCA would repeal the ACA's penalty for not obtaining insurance coverage, end Medicaid expansion in 31 states and the extra federal dollars that come with it, and limit overall federal contributions to state Medicaid programs. It would replace income-based tax credits for purchasing coverage with generally less generous tax credits based on age. Insurers would be able to charge older Americans higher premiums than they can now. Taxes imposed by the ACA would be erased.

In an analysis  that reflects all amendments except the one delegating essential benefits to the states, the Congressional Budget Office estimates that the AHCA will add 24 million Americans to the ranks of the uninsured by 2026, in contrast to Trump's earlier promise of "insurance for everybody." The bill would reduce the federal deficit by $150 billion over the next 10 years.

The projected spike in the number of uninsured has roused the American Medical Association, the American College of Physicians, the American Academy of Family Physicians, and other major medical societies to oppose passage of the AHCA. The measure also is taking a beating in the polls. Only 33% of Americans think the AHCA improves on the ACA, while 48% say it doesn't, according to a recent Reuters/Ipsos poll. And a Quinnipiac University poll released yesterday reports even bleaker numbers for the bill — 17% for vs 56% against, with 26% undecided.

Follow Robert Lowes on Twitter @LowesRobert

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