After postponing Thursday’s scheduled vote, the House is now expected to vote onFriday on the Republican health care bill known as the American Health Care Act (AHCA). Republicans remain at odds with one another as conservatives push for a complete repeal of Obamacare while moderates worry about the number of people wholikelywill lose coverage.
Meanwhile, the Congressional Budget Office (CBO) on Thursday sent House Speaker Paul Ryan an updatedanalysisof the plan, indicating a greater cost but not increasing the number of people insured. Aninitial reportestimated that the AHCA would reduce federal deficits by $337 billion. The March 23 estimate, however, calculates a $150 billion reduction.
And the number of people who likely will be uninsured remains the same: In just one year, the CBO, a nonpartisan office, predicts 14 million more people will be uninsured than if the Affordable Care Act known as Obamacare were to be left in place.
“In 2026, an estimated 52 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law,” the CBO predicts.
The House Freedom Caucus, a conservative group of House Republicans, has been strongly pushing for “essential health benefits” to be removed from the plan. These benefits include maternity care, addiction treatment, annual well visits and mental health services. Last-minute changes were made to the bill Thursday after negotiations under Amendment 31, including giving states the power to provide these “essential health benefits.” (The other benefits include prescription medication, emergency services, hospitalization and surgery, laboratory services, outpatient care, pediatric care, prenatal and postnatal care and rehabilitative care.)
Negotiations with conservative holdouts will likely result in cuts for mental health services, maternity care and addiction treatment and severely impact low-income Americans. Changes not to take place until after the midterm elections.
Eliminating the essential health benefits completely 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.
A revised version of the bill also proposes even more cuts to Medicaid than the original. The bill will allow states to require Medicaid recipients to work or partake in community service or job training. Obamacare does not require recipients to work to be eligible for the program.
Rep. Jeff Duncan (R-S.C.), a member of the Caucus, called Medicare and Medicaid “big bureaucratic nightmares” in a commentary published in theDaily Signal.
According to aKaiser Family Foundation analysis, nearly 8 in 10 adults on Medicaid live in working families. Of the more than 70 million Medicaid enrollees, about 9.8 million do not work. Thirty-five percent report an illness or disability that prevents them from working, and 28 percent have at-home and/or family responsibilities that prevent them from working. Eighteen percent are going to school, 8 percent are retired, 8 percent could not find work, and 3 percent reported a different reason.
The new bill would also give states the option to receive block grants for Medicaid recipients, no matter how many people in the state are enrolled. Additionally, states would have the option to immediately cease the expansion of Medicaid instead of waiting until 2020.
Low-income and older members of the population will be adversely affected by the proposed plan, with analysts suggesting a rise in premiums for those in their fifties and sixties.
Some Republicans announced after the meeting they cannot support the bill because it will harm many Americans.
Rep. Jaime Hererra Beutler of Washington said in a statement “we can do better than the current House replacement plan.”
“While I appreciate this week’s effort by Speaker Ryan and his leadership team to better protect older Americans from health care cost increases, the difficulties this bill would create for millions of children were left unaddressed,” Hererra Beutler said, adding, “Protecting vulnerable children is a core purpose of the Medicaid program and when the program fails to do so, it fails entirely.I will not vote to let those kids fall through the cracks.”
Rep. Charlie Dent of Pennsylvania, who voted against Obamacare, said of the ACHA, “This legislation misses the mark.”
“I believe this bill, in its current form, will lead to the loss of coverage and make insurance unaffordable for too many Americans, particularly for low-to-moderate income and older individuals,” Dent said.
A study from the nonpartisanTax Policy Centerfound 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.
Different sources have reported different numbers of Republicans who said they are leaning toward or definitely voting against the bill.CNNestimated the current number at 31, whileCBSpegged it as high as 35. Republicans can only afford 22 “no” votes on their own side for the bill to pass by a simple majority.
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.
If the bill does not pass on Friday, President Donald Trump is reportedly ready to move on and Obamacare will remain in place, sources revealed.
After Thursday’s meeting Ryan issued a brief statement to reporters.
“For seven and a half years we have been promising the American people that we will repeal and replace this broken law and tomorrow we’re proceeding,” said Ryan, who did not take any questions.