House Republicans on Monday unveiled their plans for replacing the Affordable Care Act, vowing to keep popular provisions like coverage for people with pre-existing conditions and dump others, such as the rule that requires people to buy health insurance.
Committees released two bills, which together constitute the GOP replacement effort. Each handles different sectors within the health care arena. The Energy and Commerce and Ways and Means committees are scheduled to discuss and vote on the measures Wednesday, sending them to the Budget and Rules committees and then to the full House.
One of the measures makes dramatic changes to the Affordable Care Act’s system of income-based tax credits that help people buy private insurance policies. Under the plan, eligibility would be based on age. People under 30 would receive up to $2,000 toward insurance premiums per year, for example, and people over 60 would receive up to $4,000 annually toward insurance premiums.
People who make up to $75,000 annually would receive the maximum tax credit amounts for their age. Any $1,000 in earnings over that cap would result in $100 less in tax credits, according to the bill.
“I think the goal here is to help those most in need and realize that different families have different costs and needs,” U.S. Rep. Greg Walden, R-Hood River, said in an interview with The Bulletin on Monday afternoon.
Sen. Ron Wyden, D-Oregon, the ranking member of the Senate Finance Committee, criticized the new plan in a statement Monday, saying it sends the message that tax cuts for the wealthy and special interests are more important than health care.
“The American people will pay more and get less or no coverage at all — it ends Medicaid as we know it; it decimates state and family budgets while putting America’s most vulnerable at risk; it puts the government between women and their doctors; and it steals money from Medicare to give a massive tax break to the wealthy,” he wrote.
Walden is the chairman of the Energy and Commerce Committee, whose plan seeks to deliver big changes to Medicaid programs. For one, federal funding for state Medicaid programs would be based on the number of people in the programs.
Several states, including Oregon, expanded the low-income health care program to people with higher incomes under an Affordable Care Act provision. The federal government currently covers the expansion population at 95 percent, and the pre-expansion population, in Oregon, at roughly 60 percent. The Energy and Commerce plan would drop federal funding for the expansion population down to the same level as the pre-expansion population, meaning states would have to cover the difference.
“They have to step up to the plate at a higher level at the state level,” said Walden, whose congressional district covers 20 counties in Central, Eastern and part of Southern Oregon.
More than 375,000 Oregonians joined the program under the Medicaid expansion. A report released last week by House Democrats determined that Walden’s district saw the largest increase in Medicaid enrollment of any Republican congressional district.
The Affordable Care Act requires that health insurance policies cover a number of services deemed “essential,” including cancer screenings, prescription drugs, emergency services and maternity care. The plan wouldn’t change that.
The same requirement exists for state Medicaid programs. Under the proposal, states will decide what services their programs will cover starting in 2020.
“We’re just trying to give more flexibility to the states,” he said.
Many health policy wonks have criticized the idea of repealing the insurance mandate while also ensuring coverage for sick people. It’s theorized this will discourage young, healthy people from buying insurance and oversaturate the insurance market with sick people who need the coverage, thus raising costs.
Walden argued that many people are already forgoing coverage, despite the fines that are in effect for doing so. The new proposal would wipe out penalties for individuals and businesses that don’t buy coverage for themselves or their employees, effectively canceling the mandate.
The bill also includes a provision, championed by Walden, that would ensure lottery winnings are accounted for in Medicaid eligibility determinations. Walden said it’s not a “huge problem,” but it’s one that governors have brought to his attention.
“Right now, there aren’t a lot of lottery winners, I would confess, but there are hundreds of them likely around the country who can remain on Medicaid even after winning the lottery,” he said.
Walden, whose committee will discuss the proposal at 10:30 a.m. Eastern time Wednesday, said he wanted to get the proposal out ahead of that hearing to allow for transparency.
“There are still multiple opportunities between here and when it comes to the floor for it to be modified,” he said.
Other provisions in the bills include:
• Retains the current provision that lets kids stay on parents’ insurance plans until age 26.
• Postpones the implementation of a tax on high-cost employer-sponsored health plans, or “Cadillac” plans, from Dec. 31, 2019, to Jan. 1, 2025.
• Repeals a 2.3 percent tax on certain medical devices after Dec. 31, 2017.
(Editor’s note: This article has been corrected. The original article misstated proposed coverage changes. The plan would keep the essential health benefit coverage requirement in health insurance policies.
The Bulletin regrets the error.)
— Reporter: 541-383-0304,