Health care overhaul scores early triumph despite opposition
WASHINGTON — House Republicans scored a pre-dawn triumph Thursday in their effort to scuttle former President Barack Obama's health care overhaul, but it masked deeper problems as hospitals, doctors and consumer groups mounted intensifying opposition to the GOP health care drive.
After nearly 18 hours of debate and over two dozen party-line votes, Republicans pushed legislation through the Ways and Means Committee abolishing the tax penalty Obama's statute imposes on people who don't purchase insurance and reshaping how millions of Americans buy medical care.
It was a victory of high symbolism because Obama's so-called individual mandate is perhaps the part of the statute that Republicans most detest.
Even so, the White House and Republican leaders confront a GOP and outside groups badly divided over the party's high-stakes overhaul crusade.
The American Medical Association, the American Hospital Association and AARP, the nation's largest advocacy group for older people, were arrayed against the measure. Seven years ago their backing was instrumental in enacting Obama's health care statute, which President Donald Trump and Republicans are intent on erasing.
The hospitals — major employers in many districts — wrote lawmakers complaining about the bill's cuts in Medicaid and other programs and said more uninsured Americans seem likely, adding, "We ask Congress to protect our patients." Groups representing public, children's, Catholic and other hospitals also expressed opposition.
America's Health Insurance Plans, representing insurers, praised the legislation's elimination of health industry taxes but warned that proposed Medicaid changes "could result in unnecessary disruptions in the coverage and care beneficiaries depend on."
The legislation would defang Obama's requirement that everyone buy insurance by repealing the tax fines imposed on those who don't. That penalty has been a stick aimed at pressing healthy people to purchase policies. The bill would replace income-based subsidies Obama provided with tax credits based more on age, and insurers would charge higher premiums for customers who drop coverage for over two months.
"That's what this whole bill was about, kicking people who weren't politically popular," Ways and Means Chairman Kevin Brady, R-Texas, said of Obama's overhaul.
Ways and Means members worked till nearly 4:30 a.m. EST before approving the final batch of tax provisions in a party-line 23-16 vote. The Energy and Commerce Committee panel continued working Thursday morning, tackling a reshaping of Medicaid.
Conservative lawmakers and allied outside groups claimed the bill took too timid a whack at Obama's law. Numerous GOP centrists and governors were antagonistic, worried their states could lose Medicaid payments and face higher costs for hospitals having to treat growing numbers of uninsured people.
Top Republicans knew if the upheaval should snowball and crush the legislation it would be a shattering defeat for Trump and the GOP, so leaders hoped approval by both House committees would fuel momentum.
In words aimed at recalcitrant colleagues, House Speaker Paul Ryan, R-Wis., told reporters: "This is what good, conservative health care reform looks like. It is bold and it is long overdue, and it is us fulfilling our promises." The last was a nod to campaign pledges by Trump and many GOP congressional candidates.
Ramping up pressure on GOP dissidents, a political group close to House Republican leaders said it is launching a TV ad campaign targeting 30 conservative lawmakers, mostly members of the hard line conservative House Freedom Caucus. The American Action Network said it was spending $500,000 on an ad contrasting the Republican bill with Obama's law. It ends with the announcer urging viewers to tell their representative "to vote with President Trump."
Outnumbered Democrats used the panels' meetings for political messaging, futilely offering amendments aimed at preventing the bill from raising deficits, kicking people off coverage or boosting consumers' out-of-pocket costs. They tried unsuccessfully to insert language pressuring Trump to release his income tax returns, and failed to prevent Republicans from restoring insurance companies' tax deductions for executive salaries above $500,000 — a break Obama's law killed.
There were signs of growing White House engagement, and perhaps progress.
Trump met at the White House late Wednesday with leaders of six conservative groups that have opposed the GOP legislation, and several voiced optimism afterward.
"I'm encouraged that the president indicated they're pushing to make changes in the bill," said David McIntosh, head of the Club for Growth, though he provided no specifics.
The extra billions Washington has sent states to expand the federal-state Medicaid program would begin ending in 2020, and spending on the entire program would be capped at per-patient limits. Around $600 billion in 10-year tax boosts that Obama's statute imposed on wealthy Americans and others to finance his overhaul would be repealed. Insurers could charge older customers five times more than younger ones instead of the current 3-1 limit, but would still be required to include children up to age 26 in family policies, and they would be barred from imposing annual or lifetime benefit caps.
The measure would also repeal taxes Obama's law imposed on segments of the medical industry to help pay for his statute's expanded coverage.
Democrats said the Republicans would yank health coverage from many of the 20 million Americans who gained it under Obama's statute, and drive up costs for others because the GOP tax breaks would be skimpier than existing subsidies. And they accused Republicans of hiding bad news by moving ahead without official estimates from the nonpartisan Congressional Budget Office on the bill's cost to taxpayers and anticipated coverage.
"You can expect more town hall meetings you won't want to go to," said Rep. Sander Levin, D-Mich., a reference to liberal activists who hounded Republicans during last month's recess.
A look at the opposing sides on the GOP health care bill
A look at opposing sides as Congress considers proposed Republican changes to the Obama administration health law.
SUPPORTING THE BILL:
President Donald Trump: "We're going to do something that's great and I'm proud to support the replacement plan released by the House of Representatives."
Vice President Mike Pence: "I really do believe this is an extraordinarily important moment in the life of our nation, and every American who longs to see us start over on health care reform that will respect the doctor-patient relationship, that will harness the power of the free marketplace to lower the cost of insurance, that will give states freedom and flexibility to improve Medicaid for our most vulnerable citizens can let their voice be heard."
House Speaker Paul Ryan, R-Wis.: "It repeals Obamacare's taxes, it repeals Obamacare's spending, it repeals Obamacare's mandates. It creates a vibrant market where insurance companies compete for your business, where you have lower costs, more choices, and greater control over your health care. And it returns power — this is most important — this returns power from Washington back to doctors and patients, back to states. This is what good, conservative health care reform looks like."
Senate Majority Leader Mitch McConnell, R-Ky.: "This isn't a law that can be fixed. This isn't a law that can be saved. It has to be repealed and replaced. We promised the American people we would. We're keeping our promise."
Neil Bradley, U.S. Chamber of Commerce: "Critically important provisions in the recommendations repeal a substantial number of the most harmful provisions in the Affordable Care Act: the health insurance tax, the medical device tax, and the tax on prescription medications; restrictions on the use and limitations on contributions to health savings accounts and flexible spending accounts; and the penalties associated with the employer mandate."
OPPOSED TO THE BILL:
Senate Minority Leader Chuck Schumer, D-N.Y.: "This is a tax cut for the wealthy with some health insurance provisions tacked alongside of it."
House Minority Leader Nancy Pelosi, D-Calif.: "If Republicans have their way, working families, older Americans, and people with disabilities will face huge new health costs."
Sen. Mike Lee, R-Utah: "We promised the American people we would drain the swamp and end business as usual in Washington. This bill does not do that. We don't know how many people would use this new tax credit, we don't know how much it will cost, and we don't know if this bill will make health care more affordable for Americans. This is exactly the type of backroom dealing and rushed process that we criticized Democrats for, and it is not what we promised the American people."
Sen. Rand Paul, R-Ky.: "It still looks like Obamacare Lite to me. It's going to have to be better."
Conservative advocacy groups Americans for Prosperity and FreedomWorks, backed by the billionaire Koch Brothers: "As the bill stands today, it is Obamacare 2.0. Millions of Americans would never see the improvements in care they were promised, just as Obamacare failed to deliver on its promises."
David McIntosh, president of the conservative advocacy group Club for Growth: "Republicans should be offering a full and immediate repeal of Obamacare's taxes, regulations, and mandates, an end to the Medicaid expansion, and inclusion of free-market reforms, like interstate competition."
Andrew W. Gurman, president of the American Medical Association: "The AMA supported health system reform legislation in 2010 because it was a significant improvement on the status quo at the time; and although it was imperfect, we continue to embrace its primary goal - making high-quality, affordable health coverage accessible to all Americans. As drafted, the AHCA would result in millions of Americans losing coverage and benefits. By replacing income-based premium subsidies with age-based tax credits, the AHCA will also make coverage more expensive - if not out of reach - for poor and sick Americans. For these reasons, the AMA cannot support the AHCA as it is currently written."
Joyce A. Rogers, AARP: "This bill would weaken Medicare's fiscal sustainability, dramatically increase health care costs for Americans aged 50-64, and put at risk the health care of millions of children and adults with disabilities, and poor seniors who depend on the Medicaid program for long-term services and supports and other benefits."
Richard Pollack, president and CEO of the American Hospital Association: "It appears that the effort to restructure the Medicaid program will have the effect of making significant reductions in a program that provides services to our most vulnerable populations, and already pays providers significantly less than the cost of providing care."