With the House of Representatives set to vote today on a bill that will unravel key provisions of the Affordable Care Act, many—including healthcare industry leaders—remain deeply skeptical of the legislation’s merits.
Following a Wednesday evening meeting at the Capitol, House Majority Leader Kevin McCarthy said GOP leaders have the 216 votes they need to pass the American Health Care Act (AHCA), Roll Call reported.
“We will pass this bill. I feel great about the count,” he said.
Still, their margin is razor-thin: Politico reported that about 16 Republicans publicly oppose the bill, and the party can only afford to lose 22 votes. About a dozen members remain undecided.
Republicans last scheduled a vote on the AHCA on March 24, but pulled the bill at the last minute when it became clear that they wouldn’t have the votes to pass it. Now, the pressure is on for the House to act before lawmakers leave for a recess—if they don’t, GOP leaders worry they will lose momentum.
In a newly published op-ed on CNBC, Department of Health and Human Services Secretary Tom Price joined the GOP voices pushing for Congress to pass the bill, writing that “the time to act is now.”
“To look at the failures in our healthcare system today—to see the individuals, families and businesses squeezed by soaring premiums, sky-high deductibles, and dwindling choices—and arrive at any other conclusion is an exercise in willful blindness,” he added.
Evaluating the amendments
Heading into today’s planned vote, the AHCA has undergone two notable amendments in a bid to woo reluctant GOP lawmakers. The first revision, authored by Reps. Tom MacArthur, R-N.J., and Mark Meadows, R-N.C., allows states to apply for waivers to opt out of certain ACA provisions—including the community rating rule that prevents insurers in the individual market from charging sick consumers higher premiums than healthy ones—if they meet certain conditions. It largely moves the bill further to the right.
The second amendment, proposed just this week by Rep. Fred Upton, R-Mich., attempted to ease GOP moderates’ concerns about the initial amendment, as it effectively weakened protections for people with pre-existing conditions. Thus, the latest revision provides an additional $8 billion over a five-year period to help people with preexisting conditions who live in states that opt for those waivers.
Yet that amendment does little to actually improve upon the bill, some healthcare policy experts said. For one, how far that funding goes depends largely on how many states would opt for a waiver, according to healthcare research and consulting firm Avalere.
“Given the amount of funding in the bill, the program can only afford a few small states to opt into medical underwriting,” Caroline Pearson, senior vice president at Avalere, said in an analysis of the amendment. “If any large states receive a waiver, many chronically ill individuals could be left without access to insurance.”
Similarly, an analysis conducted by the Center for American Progress concluded that “the provision would subsidize healthcare for only about 76,000 more individuals out of the millions with pre-existing conditions.”
If used toward high-risk pools, the $8 billion would fill in only 4% of the gap in funding to sustain the pools, the group added.
To help pass bill, GOP added an $8bn sweetener for high risk pools--a paltry amount given the $190bn+ shortfall there. My @Morning_Joe chart pic.twitter.com/eEsMm26m0B
— Steven Rattner (@SteveRattner) May 4, 2017
Even Robert Graboyes, a healthcare expert at the conservative Mercatus Center, was skeptical, telling The Hill that $8 billion to fund high-risk pools is a “pittance,” and “spread over five years, it’s a fifth of a pittance.”
Some in healthcare industry not convinced
While the health insurance industry has largely remained tight-lipped about its opinion of the AHCA, one recent exception is Paul Markovich, president and CEO of Blue Shield of California.
While the current version of the bill has some positive features, such as funding to help stabilize the individual marketplaces, “the AHCA as currently drafted is flawed as well,” he wrote in a statement.
Among his qualms: The way tax credits are structured, the fact that those with lower incomes won’t get help with their deductibles and copays, the effect on people with preexisting conditions and reduced federal funding for Medicaid.
Thus, he called for a bipartisan effort to enact “reforms that build on the successes of the ACA and address the problems that remain.”
Aetna CEO Mark Bertolini, meanwhile, said during Fortune’s Brainstorm Health conference in San Diego that the government should try to fix the ACA rather than try to repeal it through budget reconciliation.
“I’ve spent enough time inside the legislative labyrinth understanding what can be done or cannot be done under reconciliation, and we cannot repeal Obamacare, ACA whatever you want to call it, without 60 votes in the Senate,” he said.
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Multiple healthcare trade and interest groups previously came out against the AHCA after the amendment that moved it further to the right. After the additional amendment, one of those groups, American Medical Association, indicated that it still was unconvinced.
“None of the legislative tweaks under consideration changes the serious harm to patients and the health care delivery system if AHCA passes,” AMA President Andrew W. Gurman wrote in a statement. “Proposed changes to the bill tinker at the edges without remedying the fundamental failing of the bill—that millions of Americans will lose their health insurance as a direct result of this proposal.”