Under criticism that they are drafting an ACA repeal in secret, House Republicans are crafting legislation that they could begin to move out of the two key House committees later this week. The White House may also release its official plan which is expected to mirror what Speaker Paul Ryan (R-WS) is pushing. The plan that Ryan has laid out behind closed doors is a desired passage through the House by the end of this month and in the Senate before the spring break that starts in the House on April 6.
The two key committees are Ways and Means which controls all taxing issues and some health programs and the Energy and Commerce which controls Medicaid and several other health programs. This comes even though there are serious disagreements on what that repeal and replace bill should include. Operating under reconciliation, the two key committees could write and pass their pieces and the House leadership could later combine it as a reconciliation bill officially the product of the Budget Committee. That could give them the chance to pass something and then to change it as they negotiate between the various House factions.
One of the key issues for conservatives is their opposition to refundable tax credits to pay for health insurance premiums. The Ryan proposals as leaked are meager but still drawing the opposition of conservatives who think such a credit creates a new entitlement. The Ryan plan would provide a tax credit of $2000 for people under 30, $2500 for people 30 to 60 and $4000 for people 60 and older. By comparison, late last year the ACA was criticized by some because premiums through the ACA exchanges increased between 116 percent to a decrease of 2 percent. The state that had that 116 percent increase was Arizona which saw its mid-level insurance plan go up to $422.00 a month. That would mean for someone between 30 to 60 buying a policy like that at $5064 a year they would pay $2564 out pocket premiums regardless of their income. The ACA allows for graduated subsidies based on income.
The overall legislation is likely to be very similar to provisions included in a leaked copy of a draft ACA repeal bill was made public by Politico and a general description Speaker Paul Ryan outlined in a white paper the week before.
In addition to the issue of tax credits, the other biggest issue is the fate of Medicaid. Members have been reacting differently to some of the key proposals including how to handle the ACA Medicaid expansion that has added 11 million Americans to the insured rolls. The leaked-draft bill does away with this by 2020 when the new tax credits start. Some expansion state Republicans (31 states took the option to expand coverage through Medicaid) are not so enthusiastic. Other proposals include allowing states to keep the expanded Medicaid but cutting back the federal reimbursement. The bill as outlined in the white paper calls for per capita caps. A fixed payment to states based on the number of people by group/category. In short, a complex block grant.
One problem for the House plan is the Congressional Budget Office scoring. They have judged the credits as too small to help poorer people afford the insurance premiums and not all that important to affluent purchasers of insurance. The House leadership is reportedly working with Senate leadership. Some observers think Ryan can beat back the House conservative opposition with some arm-twisting by the President and Administration.
In regard to the House v. Burwell case, a case that challenged President Obama’s authority to provide some subsidies, apparently the Administration will continue to make the payments while the Congress wrestles with a repeal of the ACA.