Business groups were hoping a quick repeal of the Affordable Care Act would give employers more flexibility on health care and create momentum for priorities like a tax overhaul.
Friday’s decision by House GOP leaders and President Donald Trump to abandon a vote on the Republican health plan left them less certain on both fronts.
“This is a dismal failure,” said Juanita Duggan, chief executive of the National Federation of Independent Business, a group representing small businesses. “NFIB is officially unamused, and we’re not going to let them off the hook.”
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There is no precise headcount of how many people have gained coverage because of the Affordable Care Act. And it is downright impossible to reliably estimate the number of people who might lose coverage if Congress repeals and replaces it. The “20 million” figure appears to have originated in a March 2016 report by the U.S. Department of Health and Human Services. That report declared that “the provisions of the ACA have resulted in gains in health insurance coverage for 20.0 million adults through early 2016.”
Estimates by the Heritage Foundation find that 14 million people (including children) gained public or private coverage in 2014 and 2015. Unlike government surveys, Heritage examined data from insurance company regulatory filings and from the government’s own headcount of Medicaid enrollment.
They found that 84% of the newly insured gained coverage through Medicaid and a related government program for low-income children.
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Speaker Paul Ryan and House leaders had been toiling behind closed doors for weeks assembling their Obamacare repeal bill as suspicion on the far-right simmered to a boil.
So on March 7, just hours after Ryan unveiled a plan that confirmed its worst fears, the House Freedom Caucus rushed to devise a counterstrategy.
In a conference room in the Rayburn House Office Building, the group met that evening and made a secret pact. No member would commit his vote before consulting with the entire group — not even if Trump himself called to ask for an on-the-spot commitment.
Twenty-eight of the group’s roughly three dozen members took the plunge.
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What politicians, those hardy folk, don’t understand about health care is how anxious it makes their constituents. Not suspicious, not obstinate, but anxious. Because unlike such policy questions as tax reform, health care can be an immediate life-or-death issue for you. It has to do with whether, when, and where you can get the chemo if you’re sick, and how long they’ll let you stay in the hospital when you have nobody, or nobody reliable and nearby, to care for you. To make it worse, the issue is all hopelessly complicated and complex and pits you as an individual against huge institutions—the insurance company that doesn’t answer the phone, the hospital that says “I’m afraid that’s not covered”—and you have to make the right decisions.
House Republicans pulled their health-care bill shortly before a vote on Friday, and for once the media dirge is right about a GOP defeat. This is a major blow to the Trump Presidency, the GOP majority in Congress, and especially to the cause of reforming and limiting government.
The damage is all the more acute because it was self-inflicted. President Trump was right to say on Friday that Democrats provided no help, but Democrats were never going to vote to repeal President Obama’s most important legislation. And that’s no excuse. Republicans have campaigned for more than seven years on repealing and replacing ObamaCare, and they finally have a President ready to sign it. In the clutch they choked.
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Despite days of intense negotiations and last-minute concessions to win over wavering GOP conservatives and moderates, House Republican leaders Friday failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act.
House Speaker Paul Ryan pulled the bill from consideration after he rushed to the White House to tell President Donald Trump that there weren’t the 216 votes necessary for passage.
“We came really close today, but we came up short,” he told reporters at a hastily called news conference.
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Section 202 of the AHCA contains a transitional schedule of tax credits that would apply only in 2018 and 2019. These tax credits vary by both age and income, and they are set up so that they cap Americans’ exposure to high premiums. Take a childless 40-year-old making $25,000. Under Section 202, he would be expected to pay 6.3% of his income—roughly $1,500—for out-of-pocket premiums. The tax credit covers the rest. So if he buys a policy that costs $5,000 a year, the tax credit would be $3,500. If congressional leaders continue Section 202’s tax credits past 2019, they can kill three birds with one stone: repealing more of ObamaCare, lowering premiums for everyone, and making coverage especially affordable for the working poor.
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The American Health Care Act is all about is the boldest and most conservative health-care legislation to come before Congress in decades. Bold because it dismantles the progressive health-care experiment and replaces it with a dynamic, patient-centered system. Conservative because it applies America’s founding principles—freedom, free enterprise and federalism—to the problems of the day. Repeal of ObamaCare must happen, and urgently—not because of any ideology but because American families are already paying the price of the law’s collapse. The legislation gives control of Medicaid back to the states, equips state insurance markets to take care of people with pre-existing conditions without driving up costs for everyone else, and expands health savings accounts.
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President Trump issued an ultimatum on Thursday to recalcitrant Republicans to support the American Health Care Act or see their opportunity to repeal the ACA vanish, demanding a Friday vote on a bill that appeared to lack a majority to pass. The demand, issued by his budget director, Mick Mulvaney, in an evening meeting with House Republicans, came after a marathon day of negotiating at the White House and in the Capitol in which President Trump sought to sell members of his own party on the health plan. House Speaker Paul D. Ryan emerged from the session and announced that President Trump would get his wish for a vote on Friday.
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The House GOP yanked its health-care bill on Thursday ahead of a planned vote, and perhaps they’ll reconvene on today or later. The House bill to repeal Obamacare is a realistic compromise that can improve health-care markets, and no one has offered a better policy alternative to the American Health Care Act that could pass the House and Senate. The obstacle to progress has been the 29 or so Members of the House Freedom Caucus, who have the power to deny House Speaker Paul Ryan a majority of 216 with a mere 22-vote margin of error. The Freedom Caucus blocked incremental reform progress after the GOP took Congress under President Obama, and the question is whether they will indulge the same rule-or-ruin tactics now against Mr. Trump.
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