House Republicans are rushing to vote on the latest version of their health-care bill Thursday and get past an embarrassing setback on their first major legislative item of the Trump era.
The GOP thinks it has enough support to pass the American Health Care Act, an amended version of the proposal that failed dramatically in March in the face of opposition from the party's conservative and moderate wings. The latest in a series of tweaks has House Republicans confident about its passage, even if it will face tougher opposition in the Senate, where the GOP holds a much narrower majority.
Here's what we know — and don't know — about the plan, which Republicans see as an opportunity to follow through on a campaign promise they used for most of the last decade.
- The bill reduces Affordable Care Act income-based subsidies for the individual insurance market in favor of tax credits based on age. It would do away with Obamacare's individual mandate and roll back funding for Medicaid in states that adopted it. It would get rid of Obamacare's taxes, which would benefit wealthier Americans. Companies are expected to be able to charge older Americans up to five times more under the proposal.
- Amendments to the plan have taken shape to appease both conservatives and moderates. States, in certain conditions, can get waivers so that insurers do not have to offer essential health benefits. They could also waive rules requiring that insurers not charge more for pre-existing conditions and would have to set up controversial high-risk pools for those people to buy insurance. The latest amendment to win over moderates — introduced by Rep. Fred Upton of Michigan — aims to reduce concerns about funding those pools by providing an additional $8 billion over five years for premiums or other out-of-pocket costs. (See the text of that amendment below.) Republicans contend that they will not reduce protection for people with pre-existing conditions but critics say the $8 billion isn't nearly enough money. Senate Minority Leader Chuck Schumer it's "like administering cough medicine to someone with stage 4 cancer."
- Concerns have grown that lawmakers do not have enough information about the bill to properly assess its effects before they vote on it. The nonpartisan Congressional Budget Office, which assesses the costs of bills over time, has not yet projected the costs of the amended plan. Based on the last CBO "score," another analysis may not be good news for Republicans, one potential reason why they've tried to push the bill through quickly. House Democratic Leader Rep. Nancy Pelosi claimed Wednesday that Republicans are "terrified"
aboutpeople "seeing the full consequences of their plan." During Obamacare's passage, Republicans including now-House Speaker Paul Ryan criticized Democrats for moving too quickly.
- In late March, the CBO estimated that the number of uninsured people would increase by 24 million with the plan than under current law, largely due to the rollback of Medicaid expansion. It would reduce federal deficits by $150 billion through 2026, the estimate said. Premiums were expected to rise initially but eventually fall about 10 percent over a decade.
- One of the largest concerns about the plan is rising costs for older Americans. The CBO estimated that a 21-year-old customer would see premiums about 20 to 25 percent lower than under Obamacare in 2026, but a 64-year-old would face premiums 20 to 25 percent higher. Republicans have added funding to try to offset costs for older Americans, but it is not clear how much it would blunt the effects.