GOP Healthcare Legislation Faces Long Debate before Vote on AHCA

Originally, GOP leadership hoped to send a Senate-supported bill prior to the April recess; however the bill’s current version does not have that needed Senate support. The AHCA is proving to be too liberal for many House conservatives and too conservative for many House and Senate moderates. Both sides are pushing for changes.

The conservative perspective

March 14th, President Trump held a call with House Republican leadership, including House Speaker Paul Ryan, Majority Leader Kevin McCarthy and Majority Whip Steve Scalise, to discuss adding more conservative provisions to the bill in order to garner support from the GOP far right. Even though the AHCA includes significant cuts to “tax credits” for the purchase of insurance from the ACA, House conservatives have dismissed the AHCA’s reduced tax credits as a “new entitlement” and want to see further revisions. Among other ideas suggested were to:

  • Permit governors to impose work requirements on healthy Medicaid beneficiaries
  • Phase out Medicaid expansion faster than the AHCA currently includes
  • Take administrative actions to deregulate the insurance industry (although this is unlikely to be passed under Senate Budget Reconciliation rules)

The moderate perspective

All of the aforementioned ideas are opposed by House moderates and many republican senators. While the House may still be able to secure the 216 votes needed to pass without full GOP support, the Senate can only afford to lose three of its’ 52 republican votes to pass the bill under budget reconciliation. And, Senate democrats – even those up for re-election in 2018 in states won by Trump – are not likely to support a bill with provisions opposed by republicans as too conservative.

In addition, the CBO score of the AHCA included a projection that there will be 24 million fewer insured Americans in the next decade, many of those among the nation’s poorest. In response, Republican Senators and some House moderates are seeking changes, such as making tax credits more generous for lower-income people. Literally, the polar opposite of what the House conservatives are seeking.

All of these dynamics are pointing to a contentious and prolonged battle over healthcare reform. Alegeus and our industry partners will continue to educate Congress on the common-sense consumer-driven healthcare reforms that should be included in any healthcare reform legislation.

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