House Speaker Paul Ryan / REUTERS

GOP Health Care Still in Limbo, Conservatives Push to Cut Benefits

As Republicans remain divided over the American Health Care Act (AHCA), the proposed repeal to Obamacare, conservatives are pushing for an end to “essential health benefits” that include maternity care, addiction treatment, annual well visits and mental health services.

Eliminating the essential health benefits would lower premiums, conservative lawmakers argue. However, moderates and liberals note that this would increase out-of-pocket costs for those who require the services included in this clause.

The full “essential health benefits” are:

Prescription medication

Emergency services

Hospitalization and surgery

Laboratory services

Mental health services, such as behavioral therapy, counseling, substance abuse treatments and psychotherapy

Outpatient care, which is also called ambulatory patient services

Pediatric care, including dental and vision

Prenatal and postnatal care

Preventive care in the form of general wellness checkups and chronic disease management

Rehabilitative care, including necessary equipment and devices

None of the provisions in the ACHA would take effect until 2018, with most of the changes not actually occurring until 2020 and any significant impacts being seen until then after, incidentally, midterm elections will take place in November 2018.

The House Freedom Caucus, a conservative group of House Republicans, is strongly pushing for the essential benefits to be removed from the plan. A Freedom Caucus spokesperson reported to The Washington Post that, as of Wednesday, “more than 25” members of the Caucus are opposed to the bill as written.

A spokeswoman for the House Freedom Caucus tweeted on Wednesday that Republicans need to “start over.”

House Speaker Paul Ryan has been trying to work out a deal with the Caucus. He initially said removing the essential benefits may be a violation of the Senate budget, but late Wednesday it was determined that this may not be the case.

However, Democrats note that the bill still will not be able to pass if these benefits are stripped from the bill.

“What the proponents aren’t telling conservative House Republicans is that the plan to repeal essential health benefits will almost certainly not be permissible under Senate reconciliation rules,” said a spokesperson for Senate Minority Leader Charles E. Schumer (D-N.Y.).

At least two dozen Republicans have indicated they will vote against the health care bill as is or have made strong comments against it, according to CNN. The GOP needs 216 representatives to vote in favor of it to obtain a simple majority.

Meanwhile, moderate Republicans have also come out in opposition of the bill, particularly due to the disproportionate impact it will have on the elderly and poor. Rep. Daniel Donovan of New York wrote an op-ed for the Staten Island Advance detailing why he will vote against the legislation. Of note, he writes, is the “harmful impact” the bill will have on senior citizens.

“A recent study found that charging older Americans five times more for insurance than younger people would cause about 400,000 seniors to lose their ability to afford insurance,” Donovan writes. “Seniors on fixed incomes would likely see a big jump in their healthcare expenses without a near-term reduction in premiums. We can’t burden seniors who deserve better from us!”

New Jersey Rep. Frank LoBiondo in a statement said that the current legislation would harm some of his state’s residents.

“Under the current proposal, many South Jersey residents would be left with financial hardship or without the coverage they now receive,” LoBiondo said in a statement. “Our seniors on Medicare already struggle to make each dollar stretch. Three South Jersey counties have more than 30 percent of their residents receiving Medicaid assistance. Medical professionals our hospitals, doctors, nurses are opposed.”

A study from the nonpartisan Tax Policy Center found that the wealthy would be significantly better off than other families under the proposed plan. Lower-income families would see their taxes go up, while those with moderate and higher incomes would receive breaks. In general, the study concluded, families with an income greater than $50,000 would benefit and the greater a family’s income, the greater the benefit.

“The average family with less than $10,000 of income in 2022 would be $1,420 worse off, a net reduction of more than 30 percent of the family’s income,” the study notes. “The average family with more than $200,000 of income in 2022 would be $5,640 better off, a net increase of 1.1 percent of the family’s income.”

The majority of the tax reductions would go directly to the country’s wealthiest people, the study observes.

“The average family with more than $200,000 of income would receive a $5,680 tax reduction, and this high-income group would account for 70.6 percent of the net tax decrease under the AHCA. Families with income exceeding $1,000,000 would see a tax decrease of $51,410 on average, accounting for 46.2 percent of the net tax decrease for the whole population. This decrease would amount to 1.6 percent of their income on average.”

And low-income families would be negatively impacted in other ways:

“Those with incomes below $10,000 would experience a tax decrease on average because they would become eligible for age-related premium tax credits; however, simultaneous Medicaid benefit losses for this income group would be much larger than the decrease in taxes.”

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