The Republicans’ bill to repeal and replace the Affordable Care Act cleared its first hurdle by passing a committee in the House early Thursday morning, but the legislation faces mounting criticism from the healthcare industry and other groups.
After a lengthy, contentious markup session that began Wednesday, the House Ways and Means Committee approved the American Health Care Act. The House Energy and Commerce Committee was still debating the legislation as of press time.
The bill would repeal many key tenets of the ACA, rework the Medicaid program and implement a series of reforms that echo House Speaker Paul Ryan’s previously introduced healthcare policy outline, “A Better Way.”
“After years of Obamacare’s broken promises, we’re proud to put forth a plan that presents a better way for patients and their families,” Rep. Greg Walden, R-Ore., said in his introduction of the bill as the Ways and Means session began Wednesday.
But Rep. Frank Pallone, D-N.J., had a different take.
“For seven years, Republicans claimed to have a better way, but it turns out that is nothing more than an empty slogan,” he said. After years of obstructing and sabotaging the ACA, the GOP has offered a plan that is “incredibly destructive to the little guy, the average working man and woman,” he added.
Rep. Kathy Castor, D-Fla., offered similar criticisms of the bill.
“This is a very disappointing place to start because this Republican healthcare bill will eliminate coverage for millions of Americans,” she said. And because a Congressional Budget Office scoring of the bill hasn’t been released, it’s still unclear how much the bill will cost or how many people it will cover, she said.
White House Press Secretary Sean Spicer, however, said during a press briefing Wednesday that while “there will be a score in good time,” there is reason to doubt the CBO’s assessments because some of its past projections about enrollment under the ACA missed the mark. “If you're looking at the CBO for accuracy, you're looking in the wrong place,” he said.
Yet Democrats aren’t the only ones to criticize the bill—some hardline conservatives are also not impressed.
“If Republicans move forward with this bill, they will be accepting the flawed premises of Obamacare,” Michael A. Needham, CEO of Heritage Action for America, said in an emailed statement. “Instead, they should fully repeal the failed law and begin a genuine effort to follow through on their seven-year promises to create a free market healthcare system.”
The members of the House Freedom Caucus also continued to dig in their heels on the position that the bill is nothing more than “Obamacare lite.”
We ran on full repeal. We expect full repeal -- not Obamacare lite https://t.co/GXGkJsM1vl— House Freedom Caucus (@freedomcaucus) March 8, 2017
Healthcare industry weighs in
In a recent letter (PDF) to Walden and House Ways and Means Committee Chairman Rep. Kevin Brady, R-Texas, America’s Health Insurance Plans (AHIP) expressed approval for some aspects of the bill but concern about others.
The trade group said it appreciates parts of the bill that could stabilize the individual market, such as offering a transition period in which consumers will continue to get premium tax credits, and permanently eliminating the ACA’s taxes that it argues “drive up consumer costs.”
However, AHIP is concerned about some of the Medicaid funding proposals included in the bill, saying that some key components, such as the base year selection and annual increases tied to the consumer price index for medical care, “could result in unnecessary disruptions in the coverage and care beneficiaries depend on.”
The American Medical Association was more critical, writing in a letter (PDF) to congressional leaders that it cannot support the bill.
"While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations," it said.
Similarly, the American Nurses Association expressed strong opposition to the bill in a letter (PDF) to Congress, saying it "changes Medicaid to a per capita cap funding model, eliminates the Prevention and Public Health Fund, restricts millions of women from access to critical health services, and repeals income based subsidies that millions of people rely on." These changes, the letter added," in no way will improve care for the American people."
And in its own letter to Congress, the Federation of American Hospitals said its position on AHCA and any future healthcare bills depends on the extent to which they meet several key principles, including ensuring sufficient coverage levels for Americans and rolling back Medicare hospital cuts that are imposed through “arbitrary and permanent productivity adjustments.”
Employer groups’ take
While the Pacific Business Group on Health hasn’t taken a stance on the entirety of AHCA, Kristof Stremikis, of the group’s national policy team, cautioned that it is too soon to celebrate over the fact that the bill leaves out a cap on tax breaks for employer-sponsored health plans that previously leaked drafts included.
“We’re hearing pretty strongly that while it may be deleted in this bill, it’s still very much in consideration in this larger set of tax reforms that House Republicans are preparing post-ACA,” he said in an interview Tuesday, adding that therefore, “we’re not out of the woods.”
The bill also would delay the much-criticized Cadillac tax on high-cost employer health plans until 2025, but Stremikis pointed out that also means that it “hasn’t been wiped away.”
“I think both of these proposals are pretty blunt instruments; they’re symptoms in a bigger problem of affordability and the cost of healthcare,” he said, noting that employers are taking steps to do so through means such as value-based payment reforms and new benefit designs.
Leaders from the National Business Group on Health, meanwhile, said in an emailed statement that the organization is “grateful” that the bill doesn’t impose a new tax on employer sponsored plans and that it would expand the use of health savings accounts.
But while they are happy that the Cadillac tax was delayed, the group’s leaders also pushed for a full repeal, and urged Congress to support other means of reducing healthcare spending growth “rather than taxing employers and employees on their health benefits.”