Phase Two and Three of Repeal and Replace

The GOP plans to consider legislation that would eliminate anti-trust protections, allow small businesses to form pools across the nation, institute medical liability reform, and ensure access to stop-loss insurance. This week, the House will take up the Small Business Health Fairness Act (H.R. 1101), which would allow plans across state lines for certain small businesses. The chamber will also consider the Competitive Health Insurance Reform Act (H.R. 372), which would remove an anti-trust exemption for the health insurance industry. House leadership is expected to bring the medical liability reform legislation known as the Protecting Access to Care Act (H.R. 1215) to the floor within two weeks. The bill was recently advanced by the House Judiciary Committee. It is unclear, however, if any of these measures have the requisite 60 votes to pass the Senate.

AHCA Budget Markup

The House Budget Committee advanced the repeal and replace legislation by a vote of 19-17, with three Republicans voting no: Dave Brat (R-Va.), Mark Sanford (R-S.C.) and Gary Palmer (R-Ala.). During the
markup, the Committee approved four non-binding Republican recommendations that will accompany the bill when it is sent to the Rules Committee. Republicans recommended a work requirement for able-bodied adults enrolled in Medicaid, as well as a change to the refundable tax credit that would better target low-income people while providing tax deductions for individuals with higher incomes. The Committee also recommended that states be given the option of receiving their Medicaid funding as a block grant, and that Medicaid enrollment be further limited. The House Rules Committee will decide whether any amendments will be made to the current legislation before it is considered by the full House of Representatives.

Negotiations Are Ongoing

The White House and GOP leaders are currently working with rank-and-file members who are reluctant to support a measure that does not repeal the 2010 health care law in its entirety, and which they characterize as creating a new entitlement program in the form of refundable tax credits to assist individuals in purchasing health insurance. President Trump has ensured that two changes will be made to the legislation to appease some of these members: states will have the option to impose work requirements in the Medicaid program as well as the option to receive Medicaid funding as a block grant. Other changes that have been suggested include the elimination of the penalty for a lapse in health insurance coverage, and legislating actions the administration could take to deregulate the insurance
industry. But it is still unclear whether some of these changes would pass the Senate’s rules for reconciliation.

More Help for Low-Income Individuals

Republicans in the House and Senate seem to be coming to an agreement that the refundable tax credits should be increased for older and low-income people. The push for this change is being led by Sen. John Thune (R-S.D.). Speaker of the House Paul Ryan (R-Wis.) has also said that he is looking at potential changes to the tax credits in the health care bill. It is unclear if a new CBO score for the revised bill will be available before the floor vote in the House scheduled for later this week.

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