Early Monday evening, House Republicans introduced the American Health Care Act, a plan to replace Obamacare. Read an explainer on the policies in that bill here.
Three key takeaways on the Republicans' new plan
- It is more similar to Obamacare than any previous draft bills. As I wrote in Friday's Today in Obamacare, the GOP replacement plan has consistently evolved to look more and more like the Affordable Care Act. The AHCA is no exception; it is another step closer to the existing health expansion. It extends the life of Medicaid expansion for three years and the life of Obamacare taxes for one year. Both of these programs are scaled back in the AHCA, but the fact they exist at all shows how difficult it is for Republicans to uproot a law that has been in place for seven years now — and how entrenched the Affordable Care Act has become.
- If this bill moves through the House, it will face huge hurdles in the Senate. More conservative Republicans will not like the AHCA's advanceable, refundable tax credits to help individuals purchase insurance. Analysts at Tea Party group FreedomWorks are currently reviewing the bill and "already have concerns." More moderate Republicans will be frustrated by the sunsetting of Medicaid expansion in 2020, as well as other cuts to the entitlement program.
- The Congressional Budget Office score remains the repeal/replace wildcard. The AHCA currently has no CBO score on how much it will cost and how many people it will cover. Chris Jacobs reported Monday that congressional Republicans have struggled with coverage numbers, as the nonpartisan scorekeeping agency scored one provision in particular (the cap on the employer-sponsored insurance tax exclusion) as causing 10 to 20 million Americans to lose their coverage at work. That provision is now (unsurprisingly) out of the bill. But with the smaller tax credits and sunsetting of Medicaid expansion, it seems awfully likely that the AHCA will also show a loss in coverage. That will make it difficult for House Republicans to live up to this promise that they posted late Monday night:
Early reviews are in from conservatives … and they are not good
Throughout the drafting of the replacement plans, members of the Freedom Caucus repeatedly trashed the bill as "Obamacare Lite." Early reports suggest that, after seeing the final version, they feel similarly:
Rep. Jim Jordan of Freedom Caucus trashes bill: "It's subsidies for unaffordable health care, subsidies for unaffordable premiums."— Dave Weigel (@daveweigel) March 7, 2017
The big issue: Obamacare's tax credits. Freedom Caucus legislators had lobbied hard against a bill that continued to provide advanceable, refundable tax credits to purchase coverage in the individual market. And while the subsidies in this bill are much smaller than those in Obamacare, the subsidies are still there. We don't know at this point whether these legislators will eventually stomach some level of subsidy — which GOP leadership seems intent on pursuing — or cause a major obstacle to moving the bill through the House.
That's not all: A few other provisions that ended up in the AHCA
- My colleague Emily Crockett reports that this bill will, like previous replacement bills, end Planned Parenthood's federal funding. The AHCA, per Crockett would, "bar Planned Parenthood from receiving hundreds of millions of dollars in federal Medicaid reimbursements — the majority of the organization’s federal funding." Read more from her here.
- The most surprising provision in the AHCA? For me, it was a seven-page section that bars lottery winners from enrolling on Medicaid. This was something that former Rep. Joe Pitts (R-PA) had advocated for with his No Medicaid for Jackpot Winners Act. It is unclear if any lottery winners are currently enrolled on Medicaid, but if you know of one, definitely send that information my way.
Did I miss a provision you think is important? Send me a note and tell me about it.
MAP OF THE DAY
A disproportionate number of communities that favored Trump during the election rely heavily on these foreign-trained physicians from the seven countries included in Trump's first travel ban, according to a new data set analyzed by my colleague Alvin Chang. More from him here.
Kliff's Notes: All-AHCA edition!
- Looking to read the entire bill? You can do that right here.
- The New York Times has a great visual summary of how this replacement bill stacks up to the existing Affordable Care Act.
- The Kaiser Family Foundation has an incredibly useful tool to look at how tax credits would change under the GOP replacement plan. (Note: KFF built this before the AHCA added in the $75,000 cap for credits, but the amounts for the tax credits people receive under $100,000 are still accurate.)