WASHINGTON (AP) — House Republican leaders outlined a broad plan for replacing former President Barack Obama’s signature health care law during a closed-door meeting Thursday.
Some Republicans are questioning the details and timing of how the GOP intends to deliver on its long-promised alternative to the Affordable Care Act.
“Unrealistic may be a strong word, but it is a super-large task,” Rep. Mark Walker, R-N.C., said when asked about past GOP promises to quickly deliver legislation repealing the ACA and replacing it. “We’re getting there; we’re getting closer.”
Among the options discussed at a closed-door meeting of Republicans was repealing some or all of the $1.1 trillion in taxes over 10 years that Obama’s law imposed to help finance its expansion of health coverage.
In its place, House Speaker Paul Ryan, R-Wis., is proposing taxing the value of high-cost health insurance provided by employers — an idea that is certain to draw opposition from some Republicans who have long refused to vote for tax increases.
Ryan told journalists, “We intend to introduce legislation to repeal and replace Obamacare” after Congress’ upcoming weeklong recess. He provided no details.
According to a document distributed to lawmakers and obtained by The Associated Press, Republicans would phase out the expansion of Medicaid that Obama’s law enacted. Thirty-one states received extra federal money for that program. During the phase-out period the other 19 states would also receive additional money.
Eventually, states would be given a choice of receiving either a lump sum payment of federal funds or an amount that would vary based on the number of Medicaid beneficiaries they had.
“Instead of expanding a broken program, Republicans instead want to put states in charge of their Medicaid programs,” the document says.
Medicaid remains among the most contentious parts of the GOP plan. It’s expected to pit states against each other as details of the legislation are decided.
Republicans would also eliminate the tax penalties the ACA imposes on people who don’t buy insurance. Additionally, the proposal would remove subsidies the government provides to most people buying policies through the online marketplaces the statute established.
In their place, there would be refundable tax credits and health savings accounts people could use to help afford coverage — proposals Democrats have mocked as inadequate.
Refundable credits mean that even people with low or no income would receive checks from the IRS. That has drawn opposition from conservative Republicans who say that system invites fraud.
Considering different versions
Health Secretary Tom Price addressed the lawmakers and told them President Donald Trump would back their efforts.
According to Rep. Bill Flores, R-Texas, Price also said the administration wants the House to introduce legislation before Trump produces his own package. Some Republicans have been eager for the White House to advance a proposal first because they are leery of supporting something without Trump’s backing.
Thursday’s meeting came with Congress about to start a weeklong recess. That will send lawmakers home to energized voters, mostly Democrats, who have crammed town hall meetings to complain about GOP efforts to repeal the ACA. Lawmakers are eager to have something to show constituents.
Despite the options that Ryan and other GOP leaders presented, lawmakers said they still didn’t have text for the bill or final decisions in many areas, leaving it uncertain how quickly they will be able to vote on anything.
Medicare may not be included
In a significant departure from a proposal by Ryan before Trump’s election, the options being discussed Thursday would not address Medicare, which helps pay for guaranteed health care for the elderly. Ryan has backed reshaping it into a voucher-like program that people could use to buy coverage, but Trump has said he doesn’t want to revamp Medicare.
Because of many Republicans’ opposition to abortion, the retrofitted medical system would block Planned Parenthood from receiving federal payments, which comprise nearly half its annual $1.1 billion budget.
Still lacking are cost estimates from the nonpartisan Congressional Budget Office, which are crucial, as some proposals might prove too costly for some Republicans to support.
Echoing many of his colleagues, Rep. Pete Sessions, R-Texas, remarked as he left the meeting, “The devil’s in the details.”
Still, several House Republicans say they feel hopeful they might soon reach agreement.