WASHINGTON – President Donald Trump declared Monday that “Nobody knew that health care could be so complicated.” Yet the opposite has long been painfully obvious for top congressional Republicans, who face mounting pressure to scrap the Affordable Care Act even as problems grow longer and knottier.
With the GOP-controlled Congress starting its third month of work on one of its marquee priorities, unresolved difficulties include how their substitute would handle Medicaid, whether millions of voters might lose coverage, how their proposed tax credits would work and how to pay for the costly exercise.
The nonpartisan Congressional Budget Office made things more complicated recently by giving House Republicans an informal analysis that their emerging plan would be more expensive than they hoped and cover fewer people than former President Barack Obama’s statute. The analysis was described by lobbyists speaking on condition of anonymity to discuss private conversations with congressional aides.
In a fresh blow, a leading House conservative said late Monday that he was opposing a preliminary version of GOP legislation that emerged last week. Rep. Mark Walker, R-N.C., objected that the draft would not immediately end the expansion of Medicaid under Obama’s health care overhaul and would create new tax credits to be paid to people, even if they owed little or no federal taxes.
Walker heads the Republican Study Committee, which traditionally represents most House Republicans. He said in a statement that he could not “in good conscience” recommend support without significant changes.
House Ways and Means Committee Chairman Kevin Brady, R-Texas, said Republicans have made numerous changes to that draft, but Walker’s objections underscored internal tensions over the effort.
For many in the party, those problems, while major, are outweighed by pledges they’ve made for years to repeal Obama’s 2010 law and substitute a GOP alternative. Conservatives favoring full repeal are pitted against more cautious moderates, and governors looking to curb Medicaid’s costs also worry about constituents losing coverage. But Republicans see inaction as the worst alternative and leaders may plunge ahead as soon as next week with initial House committee votes on legislation.
“I believe they have left themselves no choice. Politically they must do something,” Douglas Holtz-Eakin, a Republican economist and health analyst, said Monday.
Trump spoke about health care’s complexities on a day he held White House talks with dozens of governors worried Republicans could shift a huge financial burden to the states by curbing Medicaid, the federal-state program that helps low-income people and those in nursing homes pay bills. Republican governors told reporters later that Trump would describe some specifics of his own plan in an address Tuesday to a joint session of Congress.
Trump also met with insurance company executives concerned that uncertainty about possible GOP changes could roil the marketplace.
Trump said the current health insurance market is “going to absolutely implode”– a contention he and other Republicans have made repeatedly. With premiums, deductibles and other out-of-pockets costs increasing in many individual markets, Democrats concede that changes are needed. But they contest that dire description and have no interest in helping Republicans kill Obama’s statute.
Senate Minority Leader Chuck Schumer, D-N.Y., told reporters that Republicans have yet to win any Democratic support for their effort and said “the odds are very high” Obama’s law won’t be repealed.
Congress returned Monday from a recess that spotlighted hurdles the GOP faces.
Many Republicans endured rough receptions at town hall meetings from activist backers of Obama’s overhaul. Governors meeting in Washington received a consultant’s report warning that planned Republican cuts in Medicaid and federal subsidies for consumers buying private insurance would risk coverage for many people and serious funding gaps for states.
Sen. Lisa Murkowski, R-Alaska, said she wouldn’t support blocking federal payments to Planned Parenthood or repealing the health law’s expansion of Medicaid – two staple GOP proposals. And former House Speaker John Boehner, R-Ohio, predicted at a Florida forum last week that full repeal and replacement of Obama’s law is “not going to happen” and suggested they’d end up leaving much of the law intact.
The plan House Republicans are considering includes helping people pay doctors’ bills with tax credits based on age, not income, and expanding tax-advantaged health savings accounts. They would also gradually end Obama’s expansion of Medicaid to more low earners and the open-ended federal payments states currently receive to help pay for the program.
Although the Affordable Care Act has never been popular, public opinion polls show most Americans want changes but not a complete takedown of the law.
At the same time, a number of Republican governors have taken a different path from the congressional GOP. Instead of insisting that the law be repealed, they reached accommodations with the previous administration that allowed the statute’s Medicaid expansion to proceed in their states. According to the nonpartisan Kaiser Family Foundation, 16 states with GOP governors have expanded Medicaid.
The consequences of GOP actions could make many people unhappy – not just the 20 million covered through the law but insurers, hospitals and drug companies who have benefited from Obamacare.
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