This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at http://www.nytimes.com/2017/03/07/us/politics/affordable-care-act-obama-care-health.html

The article has changed 4 times. There is an RSS feed of changes available.

Version 2 Version 3
G.O.P. Health Bill Faces Revolt From Conservative Forces G.O.P. Health Bill Faces Revolt From Conservative Forces
(about 2 hours later)
WASHINGTON — A long-awaited plan to repeal the Affordable Care Act and remake the American health care system faced a revolt from the right on Tuesday as conservative groups and lawmakers strongly criticized a bill that Republican leaders and President Trump had hoped to push through Congress this month. WASHINGTON — After seven years of waiting longingly to annul President Barack Obama’s signature health care law, Republican leaders on Tuesday faced a sudden revolt from the right that threatened their proposal to remake the American health care system.
“This is not the Obamacare repeal bill we’ve been waiting for. It is a missed opportunity and a step in the wrong direction,” said Senator Mike Lee, Republican of Utah, who was joined by a constellation of conservative groups, including the Club for Growth, Heritage Action for America and Charles G. and David H. Koch’s Americans for Prosperity. “We promised the American people we would drain the swamp and end business as usual in Washington. This bill does not do that.” The much-anticipated House plan to repeal the Affordable Care Act also drew skepticism from some of the party’s more moderate members, whose constituents have benefited from expanded coverage in recent years.
The Republican bill, released Monday night after months of negotiation, would scrap the mandated coverage in President Barack Obama’s signature domestic achievement in favor of tax incentives to coax people to purchase health care. But the legislation maintains many of the Affordable Care Act’s mandates and basic benefits, including prohibiting insurers from denying policies for pre-existing conditions or capping benefits in a year or a lifetime. The criticism came even before lawmakers knew the cost of the replacement plan and how many people might lose their health care if it were enacted.
That has led to charges among conservatives that the bill would be nearly as disruptive to the free market as the law it is replacing, and to concern among experts that it could send insurance premiums skyrocketing, with only small tax credits to defray the cost for consumers seeking policies. House Republicans were rushing the legislation through two powerful committees — Ways and Means, and Energy and Commerce — with the hope of a full House vote next week, an extraordinarily compressed time frame considering that the legislation affects many parts of the United States economy and could alter the health care of millions of Americans.
Mr. Lee and Senator Rand Paul, Republican of Kentucky, along with several conservative House members, held a news conference Tuesday afternoon to denounce the bill — Mr. Trump’s posts on Twitter notwithstanding. “The House leadership Obamacare Lite plan has many problems,” Mr. Paul said Tuesday on Twitter. “We should be stopping mandates, taxes and entitlements not keeping them.” But the swift opposition from fellow Republicans signaled that they might have to drastically reconsider their approach, and the White House portrayed the bill as a work in progress. If more than a dozen House Republicans defect, the bill will be in jeopardy, with Democrats almost certainly united as a bloc.
While House members had yet to return from their districts Tuesday afternoon, the pressure from their years of promising to wipe out Mr. Obama’s signature legislation had arrived for payment. The conservative groups that have been the backbone of their financial and political support are already in revolt. “Doing big things is never easy,” Speaker Paul D. Ryan conceded at a news conference on Tuesday after absorbing broad-based criticism of the bill. Still, he guaranteed he would drum up the 218 votes needed for passage, saying, “The nightmare of Obamacare is about to end.”
Republicans have been counting on a stately endorsement of their plan from Mr. Trump, who is widely viewed as the tugboat that will be needed to bring the large, last-minute bill over the line. While his Twitter posts on Tuesday were generally supportive of the House plan, he raised the idea that the bill was “out for review and negotiation,” hardly an unqualified endorsement. And the White House appears to have no plans for the kind of barnstorming efforts that past presidents have mounted to advance major pieces of legislation. The Republican bill would eliminate the mandate for most Americans in favor of a new system of tax credits to induce people to buy insurance on the open market. It would also eventually roll back the expansion of Medicaid that has provided coverage to more than 10 million people in 31 states.
In essence, House Republicans may have backed themselves into a political corner. They accomplished too little in shrinking the size of the government’s role in the health sector to pull the most conservative members their way, yet they may not have done enough to allay the concerns of Republican senators who are skeptical of elements like rolling back the Medicaid expansion and the defunding of Planned Parenthood, at least in the short run. Vice President Mike Pence met Tuesday with conservative members of the House to assure them that their feedback was still being considered, and President Trump entertained a group of House Republicans charged with persuading their colleagues to vote for the measure.
For example, the tax credits offered in the plan do not appear to adjust for states with higher market costs, a red flag for senators from states like North Carolina, which may explain why one of that state’s Republican senators, Richard M. Burr, called the House plan on Tuesday “a good first step toward providing relief from the broken promises, costly mandates and government bureaucracy created by Obamacare.” “We’re going to do something that’s great, and I am proud to support the replacement plan released by the House of Representatives,” Mr. Trump said. “This will be a plan where you can choose your doctor, and this will be a plan where you can choose your plan. And you know what the plan is. This is the plan. It’s a complicated process, but actually it’s very simple, it’s called good health care.”
In an interview with a local radio station on Tuesday, Senator Roy Blunt, Republican of Missouri, said, “What I don’t like is it may not be a plan that gets a majority of votes and lets us move on, because I think we can’t stay where we are with the plan we’ve got now.” Some White House officials insist that Mr. Trump will be directly engaged in persuading lawmakers to back the bill.
What’s more, Republicans have opened themselves up to the same criticisms that they leveraged at Democrats in 2010 about the process and transparency of legislating. The bill is going to two House committees on Wednesday for simultaneous revisions a mere two days after being released — and before the Congressional Budget Office has determined how much the measure would cost and how many people would lose or gain insurance. If the bill is passed by the full House as early as next week, Senator Mitch McConnell has promised to bring it immediately to the Senate floor without a single hearing. But many of the factions that provided financial and political support to back Republicans who vowed to wipe out the Affordable Care Act are nowhere near satisfied with the option rolled out on Monday.
Noting that they expected no help from Democrats, Senator John Cornyn of Texas, the No. 2 Republican, said the decision had been made to cobble together the final draft among Republicans from both chambers. “There’s already been a lot of consulting on a bicameral basis,” he said. “We’re not going to do this with Democrats.” “This is not the Obamacare repeal bill we’ve been waiting for,” said Senator Mike Lee, Republican of Utah, who was joined by a constellation of conservative groups, including the Club for Growth, Heritage Action for America and Charles G. and David H. Koch’s Americans for Prosperity. “It is a missed opportunity and a step in the wrong direction. We promised the American people we would drain the swamp and end business as usual in Washington. This bill does not do that.”
“Republicans are irresponsibly rushing forward before this bill even receives a score from C.B.O.,” Senator Chuck Schumer of New York, the Democratic leader, said on the Senate floor on Tuesday. “After years of howling at the moon about Democrats rushing through the Affordable Care Act — the mantra they said over and over and over again on the floor here and in the House, ‘read the bill’ — Republicans are having committee votes two days after the bill is released. No wonder they don’t want anyone to know what’s in the bill.” The Republican bill would scrap the mandated coverage in the Affordable Care Act in favor of tax incentives to coax people to purchase health care. But the legislation maintains many of the act’s mandates and basic benefits, including prohibiting insurers from denying policies for pre-existing conditions or capping benefits in a year or a lifetime.
Even some Republicans were squeamish. “We need to see the score,” said Senator Bill Cassidy, Republican of Louisiana, who has a more moderate bill of his own to replace the law. “It would be difficult for me personally to make such a vote” without one, he added. Some conservatives have labeled the House plan “Obamacare lite,” saying it is nearly as intrusive in the insurance market as the law it would replace. In particular, they dislike the delay in getting rid of the law’s Medicaid expansion. They also dislike the tax credits in the Republican plan, which can exceed the amount a consumer actually owes in federal income taxes, meaning that the Internal Revenue Service would be issuing checks to cover insurance premiums. The House plan also maintains many of the demands on insurers that the Affordable Care Act has, including a defined suite of “essential benefits” that all insurers must offer.
Senator Heidi Heitkamp of North Dakota, the sort of moderate Democrat that Republicans had hoped to help them tweak the law next year, said she understood that Republicans might believe they have been out front with their ideas for years. “But to not have metrics and evaluative tools” would make it hard to accept the current version, she said. Representative Jim Jordan, Republican of Ohio, said that he would introduce a “clean repeal” bill and that Senator Rand Paul, Republican of Kentucky, would offer a companion bill.
“The challenge I have is I agree that there are a number of things in the law that need to be fixed,” she said, but that Republicans are now “taking the whole structure and tearing it down.” Republicans have been counting on Mr. Trump to use his influence to persuade wavering members to support the plan. But despite his characterization of the bill as “tremendous” on Tuesday, others in his administration seemed to concede that changes, perhaps major ones, were likely.
Speaking to reporters after meeting with Senate Republicans at the Capitol, Mr. Pence offered the White House’s imprimatur, calling the bill the “framework for reform.” He added that the administration was “certainly open to improvements,” making clear that the wrangling had just begun. Tom Price, the secretary of health and human services, said twice at a briefing with reporters at the White House that the bill was “a work in progress.”
He also suggested that some provisions Mr. Trump is seeking, like the ability to buy insurance across state lines and the lowering of drug prices, might be addressed through regulation.
Representative Mark Meadows, Republican of North Carolina, said Mr. Pence had portrayed the bill as a work in progress that would no doubt be amended, perhaps significantly. “The bill that was introduced last night is still open for negotiation and certainly for modification,” Mr. Meadows said. “And we took that as very encouraging news.”
Even with substantial changes, passage of the bill is in no way assured. House Republicans accomplished too little in shrinking the size of the government’s role in the health sector to pull the most conservative members their way, yet they may not have done enough to allay the concerns of some Republican senators who are skeptical of elements like rolling back the Medicaid expansion and defunding Planned Parenthood.
In an interview with a radio station on Tuesday, Senator Roy Blunt, Republican of Missouri, said, “What I don’t like is it may not be a plan that gets a majority of votes and lets us move on, because I think we can’t stay where we are with the plan we’ve got now.”
The response from insurers was largely muted on Tuesday. They have praised the initial steps taken by the administration to stabilize the individual market, and they said they were encouraged by the desire to provide a smooth transition in the next two years. But several questioned the adequacy of the tax credits.
“It is important that the tax credit for 2020 creates a marketplace that enables people to get the coverage they need at a price they can afford,” Alissa Fox, a senior vice president at the BlueCross BlueShield Association, said in a statement. “We look forward to working with Congress to create a stable and affordable private market.”
By proceeding so swiftly, and largely in secret, Republicans have opened themselves to the same criticisms that they leveled at Democrats in 2010. If the bill is passed by the full House as early as next week, Senator Mitch McConnell of Kentucky, the majority leader, has promised to bring it immediately to the Senate floor without a single hearing.
“After years of howling at the moon about Democrats rushing through the Affordable Care Act — the mantra they said over and over and over again on the floor here and in the House, ‘read the bill’ — Republicans are having committee votes two days after the bill is released,” Senator Chuck Schumer of New York, the Democratic leader, said on the Senate floor. “No wonder they don’t want anyone to know what’s in the bill.”