Conservatives, including Perry, not sold on health care bill
WASHINGTON — President Donald Trump and his top health official praised the new House Republican health care legislation Tuesday, even as surging conservative opposition complicated party leaders’ drive to sell the proposal to rank-and-file lawmakers and the public.
U.S. Rep. Scott Perry, R-Dillsburg, said in a statement that he supports repealing the Affordable Care Act, but he's still concerned about the alternative.
"We need something that significantly reduces costs, increases access, provides the flexibility to choose your coverage and reconnects patients with their providers — with less decision-making by the insurance companies," Perry said in the statement.
A spokeswoman for Sen. Pat Toomey, R-Pennsylvania, did not respond to a request for comment.
Pushback: Trump started Tuesday morning with a tweet lauding “our wonderful new Healthcare Bill.” Shortly afterward, Health Secretary Tom Price wrote to the chairmen of the two House committees that wrote the measures, saying “they align with the president’s goal of rescuing Americans from the failures of the Affordable Care Act,” former President Barack Obama’s prized 2010 law.
Yet by lunchtime, conservative lawmakers and others were blasting the bill, underscoring the challenge Republicans face in pushing one of their top priorities to passage.
The legislation would primarily affect some 20 million people who purchase their own private health plans directly from an insurer and the more than 70 million covered by Medicaid, the federal-state program for low-income people.
In the first official, though partial, measurement to emerge of the bill’s financial impact, Congress’ nonpartisan Joint Committee on Taxation estimated it would cut more than 20 taxes imposed by Obama’s law at a cost of nearly $600 billion over a decade. The bulk of the savings would go to the wealthy.
The estimate did not include the cost of tax credits the measure proposes to help people buy coverage.
Republicans say they’ve not yet received an estimate of the bill’s overall cost or the number of people it would cover from the Congressional Budget Office.
“What 'Obamacare' did was make insurance affordable but care impossible to actually afford,” White House budget chief Mick Mulvaney said on NBC’s “Today Show.” “The deductibles were simply too high. So people could say they have coverage but they couldn’t actually get the medical care they needed when they get sick.”
“Obamacare” plans did typically come with high deductibles, but the law also provided cost-sharing subsidies to people with modest incomes. Those subsidies will be eliminated under the Republican plan, and it’s unclear how high the deductibles would be under the new approach.
Voting: House committees planned to begin voting on the legislation Wednesday, launching what could be the year’s defining battle in Congress and capping seven years of GOP vows to repeal the 2010 Affordable Care Act. Before prevailing, leaders will have to heal internal divisions.
In his letter, Price commended GOP plans to provide millions of Americans with a refundable tax credit — meaning even people without tax liability would receive the assistance. Congressional conservatives have opposed a refundable credit, saying it would create a new entitlement program the government cannot afford.
“It is a missed opportunity and a step in the wrong direction,” said Sen. Mike Lee, R-Utah, one of three conservative senators who’ve criticized GOP leaders for not aggressively repealing Obama’s law. He said it was unknown if the bill would make health care more affordable.
Conservative groups such as Heritage Action for America and the Club for Growth also piled on. Club for Growth President David McIntosh called the measure a “warmed-over substitute for government-run health care.”
“As Republicans we have a choice,” House Ways and Means Chairman Kevin Brady, R-Texas, an author of the measure, told reporters. “We can act now or we can keep fiddling around and squander this opportunity to repeal ‘Obamacare.’”
The Republican legislation would limit future federal funding for Medicaid, which covers low-income people, about 1 in 5 Americans. And it would loosen rules that Obama’s law imposed for health plans directly purchased by individuals while also scaling back insurance subsidies.
Republicans say their solutions would make Medicaid more cost-efficient without punishing the poor and disabled, while spurring private insurers to offer attractive products for the estimated 20 million consumers in the market for individual policies.
In Pennsylvania: A spokeswoman for Sen. Bob Casey, D-Pennsylvania, did not return a request for comment, but Casey posted several comments on his Twitter account critical of the proposal, particularly of future cuts to Medicaid.
"Medicaid is vital for seniors, those with disabilities and low incomes and the GOP are selling snake oil as a viable replacement," Casey tweeted.
Pennsylvania Gov. Tom Wolf’s administration and Pennsylvania’s hospitals slammed the Republican plan, describing broad ripple effects that would shift health care costs to states, hospitals and the poor.
Wolf said it would leave fewer people insured and hurt coverage for the elderly, the disabled and people seeking addiction treatment in the midst of a drug epidemic. He urged Pennsylvania’s members of Congress — which includes the nation’s third-biggest delegation of Republicans — to reject the bill.
“This is a bad plan that would leave thousands of Pennsylvania seniors and families unable to afford access to basic medical care coverage,” Wolf said in a statement.
The Hospital and Healthsystem Association of Pennsylvania said the proposal would jeopardize gains in coverage and improvements to access to care made under the Affordable Care Act.
Overall, the hospital association and Democratic governor said the bill threatens coverage not only for more than 1 million Pennsylvanians who gained it under the existing law, but for another 2 million on Medicaid.
In Pennsylvania, 2.7 million of the state’s 12.8 million residents are on Medicaid, or more than 1 in 5. That includes children, nursing home patients and the disabled. Some 700,000 are covered under the law’s expansion of income guidelines to cover low-income working adults. Meanwhile, more than 340,000 Pennsylvanians qualified for a tax subsidy to help pay for a 2017 policy through the Affordable Care Act.
Shifting costs: Democrats say the bill would make many people uninsured, shifting costs to states and hospital systems that act as providers of last resort. Individual policy holders might be able to find low-premium plans only to be exposed to higher deductibles and copayments.
The plan would repeal the unpopular fines on people who don’t carry health insurance. It would replace income-based subsidies the law provides to help millions of Americans pay premiums with age-based tax credits that might be skimpier for people with low incomes. Those payments would phase out for higher-earning people.
Thirty-one states and the District of Columbia opted to expand Medicaid coverage under the Obama-era law to an estimated 11 million people. About half those states have GOP governors, who are largely reluctant to see that spending curtailed.
In another feature that could alienate moderate Republicans, the measure would block for one year federal payments to Planned Parenthood, the women’s health organization long opposed by many in the party because it provides abortions.
In a last-minute change to satisfy conservative lawmakers, businesses and unions, Republicans dropped a plan pushed by House Speaker Paul Ryan, R-Wisconsin, to impose a first-ever tax on the most generous employer-provided health plans. Instead, a similar tax imposed by Obama’s law on expensive plans set to take effect in 2020 would now begin in 2025.
Popular consumer protections in the Obama law would be retained, such as insurance safeguards for people with pre-existing medical problems and parents’ ability to keep young adult children on their insurance until age 26.
To prod healthier people to buy policies, insurers would boost premiums by 30 percent for consumers who let insurance lapse.
— Staff writer David Weissman and The Associated Press contributed to this report.