House Republicans released draft legislation Monday to replace former president Barack Obama’s signature health care law, proposing to phase out the Affordable Care Act's Medicaid expansion and change the law's subsidies for private insurance.
“It is Obamacare gone," House Ways and Means Chairman Kevin Brady, R-Texas, told Fox News. "There’s nothing left there.”
The bill's details released Monday do not say how many people would have coverage compared with Obamacare. But federal support would be reduced to allow Republicans to repeal the law's tax increases on the wealthy, insurance companies, drugmakers and others.
The bill would also repeal the requirements that most people buy insurance and larger employers provide it.
It would still allow adult children to stay on their parents' plans until age 26. And the bill would not repeal the popular provision barring insurance companies from denying coverage to people with pre-existing health problems. Instead, to keep people from buying coverage only when they need it, insurers could raise premiums 30% for those jumping back into the market.
The legislation is already under attack not only from Democrats but from some Republicans who have raised concerns about eliminating coverage for millions of people who got coverage under the bill's expanded Medicaid eligibility. In addition, some of the most conservative Republicans have warned that the replacement tax credits the bill provided to help people buy insurance would be just another entitlement program.
House committees are expected to take up the legislation later this week.
“We deliver on President Trump’s promise to repeal and to begin replacing," Brady said.
States that expanded Medicaid under the Affordable Care Act to people earning up to 138% of poverty could still get federal funding for those enrolled before January 2020. But if those beneficiaries left the program, the federal funding would disappear.
States would also no longer receive an open-ended federal match on the amount they spend on all Medicaid beneficiaries. Instead, they would be given a set amount based on the number of enrollees in different coverage categories, such as the disabled, aged and children.
“What we want to do is restore power to the states put Medicaid on a budget," Oregon Republican Rep. Greg Walden, chairman of the House Energy and Commerce Committee, told Fox News.
Four Republican senators — Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska — said Monday they were concerned that an early draft of the bill had not provided enough “stability and certainty” for families covered by the Medicaid expansion. They said any replacement plan offer a “stable transition period and the opportunity to gradually phase-in their populations to any new Medicaid financing structure.”
It was not immediately clear whether the bill unveiled Monday night would put those concerns to rest.
Some conservative Republicans have complained about the subsidies that would replace the tax credits the ACA provides to help people earning up to 400% of poverty buy private insurance if they're not offered plans through a job.
The GOP alternative offers refundable credits that become more generous with age. Unlike an earlier draft, the credits phase out at higher income levels. But at lower income levels, recipients can still receive a larger credit than the amount of taxes they owe, which has raised concerns among some Republicans.
The tax credits would range from $2,000 to $14,000 a year.
Those receiving tax credits can use them to purchase any insurance plans, not just those sold on the exchanges created by the Affordable Care Act. That would include purchasing “catastrophic” plans that offer limited coverage. They could not use the credits for plans that cover abortion services.
Democrats across the board have promised to fight any changes to the law that would scale back health care coverage.
Oregon Sen. Ron Wyden, the top Democrat on the Senate Finance Committee, said Americans would pay more and get less coverage under the GOP bill.
“This bill sends a loud and clear message: tax cuts for special interests and the wealthy matter more than your health care," he said in a statement. “Congressional Republicans are leading a desperate forced march to pass a dangerous bill written in secret which few members of Congress have seen, let alone read."
The new version of the bill no longer includes a provision included in the draft to limit the existing tax exemption on employer-provided plans. As before the ACA passed, neither employers nor their workers are taxed on the value of health care coverage provided through a job. An earlier version of the bill would have imposed a tax on more generous plans. That was opposed by business groups and labor unions.
The ACA imposed a tax on high-cost plans, which has been delayed until 2020. The GOP bill would repeal that tax, but it would come back in 10 years in order to keep the bill within cost limits.
The bill increases the tax benefits for health savings accounts, raising the limits on how much people can put aside for health expenses.
Ron Pollack, executive director of the advocacy group Families USA, said the bill doesn't deliver on Trump's promise to offer "insurance for everybody" that is "much less expensive and much better."
"This bill would strip coverage from millions of people and drive up consumer costs," he said.
Contributing: Eliza Collins