Republicans give Obamacare fix mixed reviews

WASHINGTON—House Republicans unveiled Obamacare repeal-and-replace legislation Monday evening, but they still face a long road to overhaul America’s healthcare system.

“Working together, this unified Republican government will deliver relief and peace of mind to the millions of Americans suffering under Obamacare,” said House Speaker Paul Ryan, R-Wis., in a statement announcing the new legislation.

The plan comes out of two committee bills in the House Energy and Commerce and Ways and Means committees that, together, GOP leadership calls the American Health Care Act. Republicans have promised to take down Obamacare, officially called the Affordable Care Act (ACA), since it became law in 2010. But now after debuting the first realistic alternative, party leaders have to work to gain the full conference’s support.

Moments after the release of the text of the American Health Care Act, House Freedom Caucus member Rep. Justin Amash, R-Mich., tweeted the plan was “Obamacare 2.0.” Rep. Dave Brat, R-Va., another Freedom Caucus member, told Politico he would vote against the legislation in its current form.

Sen. Rand Paul, R-Ky., who was a part of a trio of Republicans who vowed to vote against early drafts of the bill, called the final version “Obamacare Lite.”

“It will not pass. Conservatives are not going to take it,” Paul tweeted.

With no Democrats expected to vote to pass the bill, House Republicans can afford to lose no more than 21 votes from their own caucus.

The Republican healthcare replacement strips the Affordable Care Act of many elements conservatives have loathed for years. The plan cuts all Obamacare taxes and expensive subsidies and does away with both the individual and employer mandates. It keeps in place several of Obamacare’s most popular features, including guaranteeing coverage for pre-existing conditions and letting young adults stay on their parents’ health plans until age 26.

Additionally, the plan includes language to direct federal funds away from the nation’s largest abortion provider, Planned Parenthood.

After reviewing the plan, President Donald Trump expressed his support.

“Our wonderful new Healthcare Bill is now out for review and negotiation,” Trump tweeted. “Obamacare is a complete and total disaster—is imploding fast!”

The new plan puts a stop to Medicaid expansion by placing a cap on federal payments. It allows 31 states plus Washington, D.C., to keep the Medicaid expansions they enacted under Obamacare. The other 19 states cannot grow Medicaid further but can receive $10 billion spread over five years to treat poor patients.

To help defray out-of-pocket costs, the Republican plan grants refundable tax credits for Americans making less than $75,000 a year. It offers $2,000 per year for people under 30 and $4,000 per year for those age 60 and up. For each additional $1,000 of income over $75,000, individuals would receive $100 less in credit.

For fiscal hardliners, the tax credit proposal will make the plan difficult to support.

“This is a Republican welfare entitlement,” said a memo from the Republican Study Committee, which represents more than 150 House Republicans. “Writing checks to individuals to purchase insurance is, in principle, Obamacare. It does allow more choices for individuals, and is more patient-centered, but is fundamentally grounded on the idea that the federal government should fund insurance purchases.”

Trump has said repeatedly Obamacare is a disaster but has also expressed he doesn’t want to take away anyone’s insurance. The proposed plan keeps open the insurance exchanges created under the ACA. But without subsidies, fewer people are expected to use them. That leaves those already troubled insurance plans at risk for economic failure.

“The threat of death spirals will remain,” Michael Cannon of the Cato Institute wrote in a blog post.

According to healthcare experts, the proposed plan will not be able to insure as many as the ACA.

“With Medicaid reductions and smaller tax credits, there’s no way the House GOP bill covers as many people as the ACA,” said Larry Levitt, senior vice president at the Kaiser Family Foundation.

Joe Antos, a healthcare scholar at the American Enterprise Institute, told Reuters it’s still unclear how Republicans plan to pay for their replacement package.

The House committees released the bills before the Congressional Budget Office had time to evaluate the legislation and make estimates, so many consequences of the Republican replacement package are still unknown.

But with the replacement package now on paper, GOP leadership plans to move quickly toward a vote. The House Energy and Commerce and Ways and Means committees will begin marking up the bills as soon as Wednesday. Both the Republican Study Committee and the House Freedom Caucus scheduled meetings Tuesday evening to plan their next steps.