GOP Obamacare alternative opens to mixed reviews

Republicans on Capitol Hill unveiled their long awaited alternative to Obamacare, repealing most of the bill's more odious provisions while keeping some popular parts of the original bill.

But the bill faces an uncertain future in Congress.  Conservatives in the House are sharpening their knives to defeat it, while some Senate Republicans are strongly objecting to getting rid of the Medicaid expansion contained in the original Obamacare bill.

Reuters:

Several Senate and House conservatives have already expressed doubt about another aspect of the plan, the offering of tax credits for the purchase of health insurance. The proposal seeks to encourage people to buy insurance with the age-based credits, which would be capped at upper-income levels.

The legislation would abolish the current income-based subsidies for purchasing insurance under Obamacare.

The proposal would protect two of the most popular provisions of Obamacare. It would prohibit insurers from denying coverage or charging more to those with pre-existing conditions, and it would allow adults up to age 26 to remain on their parents' health plans. Trump has long supported by both ideas.

The measure would also provide states with $100 billion to create programs for patient populations, possibly including high-risk pools to provide insurance to the sickest patients.

The overall cost of the Republican plan, a key issue in a time of high federal deficits, was not yet known, Republican aides said. Two House committees will next review the plan.

Craig Garthwaite of Northwestern University said the proposed tax credits, which would range from $2,000 to $4,000, were "frankly not enough for a low-income person to afford insurance."

Republicans said the legislation would give Americans the flexibility to make their own healthcare choices, free of Obamacare's mandate that people buy health insurance and the law's taxes, including a surtax on investment income earned by upper-income Americans.

"Our legislation transfers power from Washington back to the American people," House Ways and Means Chairman Kevin Brady said in a statement.

Senate Democratic Leader Chuck Schumer said in a statement, however, that "Trumpcare doesn’t replace the Affordable Care Act, it forces millions of Americans to pay more for less care."

"Paying for all this is going to be a big issue," said Joe Antos of the American Enterprise Institute think tank.

"It's possible that CBO (the Congressional Budget Office) is going to say the Medicaid reductions aren't enough to offset the revenue losses from repealing all the taxes."

A hospital group voiced disappointment that lawmakers were willing to consider the measure without knowing how much it cost or how it might affect healthcare coverage.

The push-pull in the Republican Party over Obamacare has always been between those who want total repeal of the bill and those who want to maintain certain popular pieces of the program.  The divide reflects those who wish to repeal Obamacare for ideological reasons and those who fear a political backlash from those citizens who may lose their insurance or pay a lot more for it.

At the moment, the two sides are light-years apart and without strong leadership from the White House, the effort may crash and burn in the most embarrassing fashion.

Gone will be the individual mandate – something that every Republican supports.  And several of Obamacare's taxes also has the support to be repealed.  Less controversial but still to be determined is the mandate against penalizing people with pre-existing conditions.  That may be replaced by some kind of risk pool that insurance companies will pay into – with help from the federal government.

Perhaps the most contentious issue will be Medicaid expansion, where about 10 million Americans were able to sign up for the Medicaid insurance program.  But that number is deceiving.  Up to two thirds of "new" Medicaid clients in the states were eligible for the program even before the Medicaid expansion passed Congress.  Presumably, they will continue to be eligible in any replacement bill.

The theory is that freeing insurance companies to offer a much wider variety of plans – without mandates on birth control, mental health, and substance abuse coverage among others – will make policies far less expensive and more available.  If that happens, the $2,000-4,000 tax credits will cover a substantial portion of a family's health insurance bill.  But no one currently knows if that will be the case.  It will be up to the CBO to "score" the GOP bill and perhaps take a shot at estimating whether the tax credits will be enough so that most Americans will still be covered under their insurance plans.

About the best that can be said of this bill is that it's a start.  But both Speaker Ryan and Majority Leader McConnell have their work cut out for them.  Cobbling together a majority in both chambers will be their greatest challenge in the new Congress.  It will also be the hardest test for President Trump and his team in his first term.

Republicans on Capitol Hill unveiled their long awaited alternative to Obamacare, repealing most of the bill's more odious provisions while keeping some popular parts of the original bill.

But the bill faces an uncertain future in Congress.  Conservatives in the House are sharpening their knives to defeat it, while some Senate Republicans are strongly objecting to getting rid of the Medicaid expansion contained in the original Obamacare bill.

Reuters:

Several Senate and House conservatives have already expressed doubt about another aspect of the plan, the offering of tax credits for the purchase of health insurance. The proposal seeks to encourage people to buy insurance with the age-based credits, which would be capped at upper-income levels.

The legislation would abolish the current income-based subsidies for purchasing insurance under Obamacare.

The proposal would protect two of the most popular provisions of Obamacare. It would prohibit insurers from denying coverage or charging more to those with pre-existing conditions, and it would allow adults up to age 26 to remain on their parents' health plans. Trump has long supported by both ideas.

The measure would also provide states with $100 billion to create programs for patient populations, possibly including high-risk pools to provide insurance to the sickest patients.

The overall cost of the Republican plan, a key issue in a time of high federal deficits, was not yet known, Republican aides said. Two House committees will next review the plan.

Craig Garthwaite of Northwestern University said the proposed tax credits, which would range from $2,000 to $4,000, were "frankly not enough for a low-income person to afford insurance."

Republicans said the legislation would give Americans the flexibility to make their own healthcare choices, free of Obamacare's mandate that people buy health insurance and the law's taxes, including a surtax on investment income earned by upper-income Americans.

"Our legislation transfers power from Washington back to the American people," House Ways and Means Chairman Kevin Brady said in a statement.

Senate Democratic Leader Chuck Schumer said in a statement, however, that "Trumpcare doesn’t replace the Affordable Care Act, it forces millions of Americans to pay more for less care."

"Paying for all this is going to be a big issue," said Joe Antos of the American Enterprise Institute think tank.

"It's possible that CBO (the Congressional Budget Office) is going to say the Medicaid reductions aren't enough to offset the revenue losses from repealing all the taxes."

A hospital group voiced disappointment that lawmakers were willing to consider the measure without knowing how much it cost or how it might affect healthcare coverage.

The push-pull in the Republican Party over Obamacare has always been between those who want total repeal of the bill and those who want to maintain certain popular pieces of the program.  The divide reflects those who wish to repeal Obamacare for ideological reasons and those who fear a political backlash from those citizens who may lose their insurance or pay a lot more for it.

At the moment, the two sides are light-years apart and without strong leadership from the White House, the effort may crash and burn in the most embarrassing fashion.

Gone will be the individual mandate – something that every Republican supports.  And several of Obamacare's taxes also has the support to be repealed.  Less controversial but still to be determined is the mandate against penalizing people with pre-existing conditions.  That may be replaced by some kind of risk pool that insurance companies will pay into – with help from the federal government.

Perhaps the most contentious issue will be Medicaid expansion, where about 10 million Americans were able to sign up for the Medicaid insurance program.  But that number is deceiving.  Up to two thirds of "new" Medicaid clients in the states were eligible for the program even before the Medicaid expansion passed Congress.  Presumably, they will continue to be eligible in any replacement bill.

The theory is that freeing insurance companies to offer a much wider variety of plans – without mandates on birth control, mental health, and substance abuse coverage among others – will make policies far less expensive and more available.  If that happens, the $2,000-4,000 tax credits will cover a substantial portion of a family's health insurance bill.  But no one currently knows if that will be the case.  It will be up to the CBO to "score" the GOP bill and perhaps take a shot at estimating whether the tax credits will be enough so that most Americans will still be covered under their insurance plans.

About the best that can be said of this bill is that it's a start.  But both Speaker Ryan and Majority Leader McConnell have their work cut out for them.  Cobbling together a majority in both chambers will be their greatest challenge in the new Congress.  It will also be the hardest test for President Trump and his team in his first term.

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