House Republican leaders, racing toward a planned Thursday vote on their proposed health-care overhaul, unveiled changes to the legislation late Monday that they think will win over enough members to secure its passage.
The tweaks addressed numerous GOP concerns about the legislation, ranging from the flexibility it would give states to administer their Medicaid programs to the amount of aid it would offer older Americans to buy insurance. They are the product of two weeks of negotiations that stretched from the Capitol to the White House to President Trump’s Florida resort.
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The draft legislative texts that will make up the American Health Care Act cleared two House committees this week amid vociferous complaints about the legislation, seemingly from all quarters. At some level this is understandable. After all, nobody expected the Democrats to stand up and applaud a replacement for the Affordable Care Act. And for Republicans, three other factors contribute. First, health-care reform is hard, and there are widely varying views of the best policy. Second, these are draft bills, not final legislation. The markup process is supposed to identify and modify unpopular provisions. Finally, the bill’s scope is limited by the budget reconciliation rules that fast-track Senate consideration. It is simply not possible to embody the full range of policy issues in a reconciliation bill, and some disappointment directly follows from what has had to be left out.
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A Republican proposal to revise the Affordable Care Act claimed its first major victories Thursday amid a backlash that both Republican leaders and President Trump spent the day trying to tamp down.
Trump met with conservative critics of the plan, signaling both a willingness to negotiate its details and that it does not yet have enough votes to emerge from the House. More acknowledgment of the proposal’s problems came from Senate Republicans, who suggested Thursday that the measure is moving too quickly through the House and in a form unlikely to succeed if it gets to the upper chamber.
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Leaders of conservative groups that oppose the House Republicans’ health-care bill met with President Trump at the White House on Wednesday night, part of a high-profile effort to quiet anger from the right. In the process, the conservatives heard the president and his team express some openness to tweaks to the bill that go further than House or Senate leaders might accept.
Trump and his team did not outright reject changes on at least three components of the GOP’s American Health Care Act, said some of the meeting’s attendees, speaking on the condition of anonymity. One idea was accelerating the timetable for key changes to Medicaid under the House GOP plan from 2020 to 2018.
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On Monday evening, House Republican leaders unveiled their long-awaited Obamacare replacement, entitled the American Health Care Act. The plan was swiftly panned by observers from all over the ideological spectrum. But there was one group whose complaints made the least sense: GOP hard-liners who believe that any attempt to provide financial assistance to the uninsured amounts to “Obamacare Lite.”
It was a phrase we heard over and over on Tuesday. “This is Obamacare Lite,” said Sen. Rand Paul (Ky.). FreedomWorks, a conservative activist group, used the same epithet. Rep. Justin Amash (Mich.) called the AHCA “Obamacare 2.0.”
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No single bill will fix all the challenges Medicaid faces, but Congress and the president have a historic opportunity to adopt permanent reforms. Working together with governors and state Medicaid reformers, we can empower states with new statutory flexibilities. We can modernize the waiver process so states can focus on managing their programs based on the needs of their patients, not managing paperwork for the Centers for Medicare and Medicaid Services. We can create better tools and incentives for states to reduce costs, boost quality and improve health outcomes.
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Congressional Republicans have been struggling for months to resolve one of the most vexing problems in their tortuous effort to replace the Affordable Care Act: What to do about the generous federal funding for states that broadened their Medicaid programs under the law, while not shortchanging the 19 states that balked at expansion?
Now, as the House begins to hone details of its legislative proposal, a possible compromise has emerged. It would temporarily keep federal dollars flowing to cover almost the entire cost of the roughly 11 million Americans who have gained Medicaid coverage but would block that enhanced funding for any new participants.
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Vice President Pence forcefully defended on Thursday night the Trump administration’s plans to repeal and replace the Affordable Care Act, saying the law known as Obamacare is a “nightmare” and that the administration is committed to “an orderly transition” to a new health care system. Pence said he and President Trump are committed to giving every American “access to quality, affordable health insurance. . . . We’ll have an orderly transition to a better health-care system that finally puts the American people first,” Pence said.
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President Trump’s statement that his preferred replacement for the ACA would provide health “insurance for everybody” surprised those who have followed the contentious debate over the health care law since its passage in 2010. In recent years, though, Republicans have emphasized that gains in insurance coverage should not be the sole barometer by which health care reform is measured. Rather, the affordability of that coverage is the key to a better health care system with fewer uninsured Americans. For too long, Republicans have shied away from calling for “universal coverage” because they’ve equated it with the Democratic push for a government-run, single-payer health-care system. But that simply isn’t the case. Market-based reforms can both lower costs and lead to health insurance coverage for more Americans. Any market-based replacement to the ACA should: (1) Expand access to consumer-directed coverage arrangements such as health savings accounts coupled with high-deductible insurance plans; (2) Tailor government assistance to individual situations; (3) Give those with preexisting conditions access to mechanisms, such as properly funded high-risk pools, to help them both acquire and afford coverage; and (4) Allow for alternative pathways to private, tax-preferred coverage, by allowing health plans to be sold across state lines, as well as by giving unions, churches or other civic organizations the opportunity to offer coverage to members.
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Republican leaders laid out an aggressive legislative agenda that would have Congress repeal major portions of Obamacare, pass replacement measures and embark on a major tax code overhaul. At their annual policy retreat in Philadelphia, the GOP put repealing and replacing Obamacare as the first order of business, with the target date for action within the next three months. They laid out a three-pronged plan—one that would start with a “reconciliation” bill that could skirt a Senate filibuster but accomplish only some of the GOP’s health care goals. Meanwhile, the Trump administration would use its executive and regulatory powers to abolish parts of the law, while lawmakers continue work on more thorough replacement legislation that would need some Democratic support.
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