When House Republicans unveiled their bill Monday to repeal and replace the Affordable Care Act (ACA), the reactions swiftly came pouring in from across the political and healthcare spheres.
Among its key provisions, the bill would end Medicaid expansion and convert funding to a per capita cap; eliminate the individual and employer mandates; offer age-based tax credits to help individuals afford coverage; expand the use of health savings accounts; and end almost all of the taxes levied by the ACA.
The bill would keep the ACA’s ban on denying coverage to those with preexisting conditions, and continue allowing young people to stay on a parent’s plan until age 26. Gone is the Republicans’ proposal to cap the amount of employees’ health insurance contributions that are tax-deductible, but the Cadillac tax would survive—just be delayed until 2025.
The law also eliminates the ACA’s cap tax deductions offered on health insurance executive salaries that are greater than $500,000 a year. “Unlike Obamacare, our legislation doesn’t include policies that discriminate against specific industries,” a Republican aide told BuzzFeed.
Still, from the health insurance industry’s main trade group, the initial response to the legislation was cautious and gave little away.
“We are reviewing the bill, with a commitment to a stable market that best ensures affordable, high-quality coverage for all Americans,” America’s Health Insurance Plans spokeswoman Kristine Grow said in an emailed statement. “By working collaboratively and in a bipartisan manner with policymakers and the administration, together we can improve healthcare in our nation.”
Republican House Speaker Paul Ryan touted the bill as one that will “drive down costs, encourage competition, and give every American access to quality, affordable health insurance.”
It also “protects young adults, patients with pre-existing conditions, and provides a stable transition so that no one has the rug pulled out from under them,” he said in a statement.
President Donald Trump was similarly enthusiastic about the bill's debut:
Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster - is imploding fast!— Donald J. Trump (@realDonaldTrump) March 7, 2017
But to Kathy Hempstead, of the Robert Wood Johnson Foundation, “it seems like this bill has the potential to cost a lot but provide relatively few benefits,” she said in an emailed statement to FierceHealthcare.
In the healthcare industry, providers probably won’t like the proposed Medicaid funding and coverage reductions, while the insurance industry will probably be concerned about the rush to eliminate the individual mandate, she said.
In addition, Hempstead predicted that “old, sick and poor people will probably lose access to affordable coverage.”
Andy Slavitt, the former Centers for Medicare & Medicaid Services acting administrator, was also critical of the bill’s implications for the Medicaid program, tweeting:
When #ACA replacement bill is out, don't get distracted by exchanges.— Andy Slavitt (@ASlavitt) March 6, 2017
The big issue is dramatic cuts in Medicaid to pay for huge tax cuts.
Sen. Chuck Schumer, who has been a vocal critic of the GOP Congress' and the Trump administration's agenda, also offered withering criticism:
Some Republicans, meanwhile, were also skeptical of their party leadership’s proposed healthcare legislation, underscoring how difficult it will be for the GOP to achieve consensus.
Sen. Rand Paul, for example, called the House GOP’s bill “Obamacare lite.” Paul has been a leading critic of Republican leaders’ handling of the bill, at one point staging a public quest to find a copy of it before they revealed it to the public.
Coming up right now on @foxandfriends Will be talking about the House Obamacare Lite plan.— Senator Rand Paul (@RandPaul) March 7, 2017
Even a Republican member of the House, Rep. Justin Amash of Michigan, expressed opposition to the bill, tweeting simply that it is “Obamacare 2.0.”