Republicans change health care bill in search for votesBy MJ Lee, Tami Luhby, Phil Mattingly and Deirdre Walsh, CNN Updated 11:23 AM ET, Tue March 21, 2017
(CNN)House Republican leaders released a package of amendments Monday evening to modify the GOP bill to repeal and replace Obamacare -- the culmination of days of negotiations and closed-door meetings to win over critics and skeptics of the proposal.
The amendments mark efforts by GOP leaders and the White
House to appease both conservatives and moderates who have
expressed reservations about the bill.
As of Monday, senior Republicans were continuing to whip the
GOP conference to ensure that they will have the 216 votes
necessary to pass the bill out of the House on Thursday. To
ramp up the pressure, President Donald Trump will meet with
lawmakers on Capitol Hill Tuesday morning.
The legislation, called the American Health Care Act, would
rewrite the current health care system and lead to millions
of more people being uninsured than under Obamacare,
according to the Congressional Budget Office.
The bill will be taken up Wednesday by the House Rules
Committee and set to be voted on by the House Thursday
-- the seven-year anniversary of President Barack Obama
signing the Affordable Care Act.
Changes to Medicaid
Many of the amendments would make additional changes to
Medicaid that were pushed by conservative members.
One addition would give states the option of requiring
able-bodied Medicaid recipients to work, participate in
job training programs or do community service.
Conservative-leaning members have been especially irked
since Obamacare expanded Medicaid to 11 million
able-bodied adults without children. Critics, however,
say it will make it harder for many low-income Americans
to get needed health care.
Also, the revised legislation would allow states to opt
to receive federal Medicaid funding as a block grant for
the adults and children in their program. The current
bill calls for giving states a set amount of money per
enrollee, known as a per capita cap system. (Funding for
elderly and disabled participants would be based on
enrollment.)
Both would be a major change from the current way
Medicaid is funded, which is open-ended federal support
tied to state spending on the program.
Under a block grant, states would receive a fixed amount
of federal funding each year, regardless of how many
participants are in the program. This would reduce
federal support for Medicaid even more since the funding
level would not adjust for increases in enrollment,
which often happens in bad economic times.
Another alteration would immediately prevent states from
expanding Medicaid, a concession to
conservative lawmakers. Under the first version of
the legislation, enhanced funding for Medicaid would be
repealed as of January 1, 2020, but nothing barred
states from expanding the program before that.
New York state
House leaders also sought to win support from centrist
Republicans from upstate New York leaders by adding a
provision that would ban the federal government from
reimbursing state Medicaid funds raised by local
governments, according to New York Rep. Chris Collins.
He told CNN the change would help bring along other
members of his state's delegation who are currently
wavering on the bill.
A House GOP aide told CNN the change would apply to New
York state only.
In New York, counties outside of New York City send $2.3
billion to the state to help pay for Medicaid. The
amendment would give the state the incentive to stop
passing down Medicaid costs to the counties, Collins
said.
Tax credits pushed to Senate
House lawmakers punted one important provision to the
Senate: Providing more assistance to older consumers,
many of whom would face huge premium hikes under the GOP
bill. The House is setting aside $75 billion to provide
additional tax credits to help people buy policies on
the individual market, but they are letting the Senate
handle the crafting of the legislation.
The American Health Care Act's tax credits are not as
generous as Obamacare's subsidies for lower-income
enrollees in their 50s and early 60s. As a result, the
premium for a 64-year-old would be 20% to 25% higher in
2026 than it would be under Obamacare, the CBO
projected.
Lawmakers have been hammered on this point, with the
influential AARP warning that it will inform all 38
million of its members how their representatives votes.
Beefing up the tax credits, however, will make the
legislation more costly. By shifting responsibility to
the Senate, lawmakers avoid having to have the CBO
re-evaluate the plan, while assuaging rank-and-file
members to support the bill.
Ways and Means Committee Chairman Kevin Brady told
reporters on Monday that older Americans were "hammered
the most by Obamacare."
"The promise of Obamacare was that if you made young
people pay more, you would pay less. And that failed,"
Brady said. "So they're facing skyrocketing premiums."
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