Washington – During a day of acrimonious partisanship over the future of America’s health care system, Rep. John Larson on Wednesday was among the Democrats who tried to alter and slow the progress of a bill that would repeal and replace the Affordable Care Act.
The American Health Care Act was the subject of twin markups in the House Ways and Means Committee, of which Larson is a member, and the Energy and Commerce Committee.
But even as Democrats introduced dozens of amendments to change the bill – even one that would require President Donald Trump to release his tax return – the GOP used its majorities on the panels to turn back the challenges.
Larson took aim at a provision of the bill that would eliminate an ACA Medicare surtax on couples earning more than $250,000 a year and individuals earning more than $200,000.
Larson and other Democrats argued elimination of the tax would cut payments to the Medicare Trust Fund by $170 billion and threaten its stability.
“What we are calling it is the Trump cabinet tax relief act,” Larson said of the GOP health plan. “Stop this tomfoolery.”
Larson and other Democrats complained the bill, released on Monday, was being rushed through committee without hearings or a Congressional Budget Office scoring of how much it would cost and how many people it would cover with health insurance.
“People at home that are scared to death can’t even get from the Congress and the government that they rely on, and competent staffs like yours…one scintilla of information in order to know what’s going to happen to their healthcare,” Larson complained.
The CBO analysis is expected next week. Meanwhile, the nonpartisan Committee for a Responsible Federal Budget estimated the American Health Care Act would cost nearly $600 billion over the nine-year life of the bill.
White House press secretary Sean Spicer launched a pre-emptive attack on the CBO on Wednesday, saying it was “way off last time” in its cost estimate of the Affordable Care Act. Spicer argued that its numbers on the Republicans’ replacement bill should not be taken as the final word and that the Trump administration plans to release its own estimated of the bill through the Office of Management and Budget.
“If you’re looking at the CBO for accuracy, you’re looking in the wrong place,” Spicer said.
Ways and Means Democrats also took aim at a provision in the bill that would eliminate an ACA cap on the tax deductions insurance companies can take on executive compensation. The ACA does not allow deductibility of compensation in excess of $500,000 a year.
Rep. Danny Davis, D-Ill., called the compensation provision “the Robin Hood in reverse plan,” and Rep. Ron Kind, D-Wis., called it “a huge giveaway for insurance companies.”
Republicans were hoping for a quick floor vote on the plan, but it looks like the debate in committee could last days. Leaders of the House Energy and Commerce Committee – where Democrats insisted on a full reading of the bill – said the markups could go “through the weekend.”
The AARP said elimination of the Medicare surcharge would “weaken Medicare’s fiscal sustainability, and other provisions of the bill would dramatically increase health care costs for Americans aged 50-64, and put at risk the health care of millions of children and adults with disabilities, and poor seniors who depend on the Medicaid program for long-term services and supports and other benefits.”
The AMA said it rejected the American Health Care Act because it would result in an increase in the uninsured, as did organizations representing hospitals.
But Republicans argue that the ACA has failed and the nation needs a stable alternative that shifts much of the authority over health care policy to the states.
“While the Affordable Care Act – or ‘Obamacare’ – has helped some, it has inflicted tremendous harm on more families, workers, and job creators nationwide,” said Rep. Kevin Brady, R-Texas, and author of the GOP bill.
Insurers have concerns too
The American Health Care Act would eliminate the ACA’s subsidies in favor of refundable, advance-able tax breaks that would run from $2,000 for those under 30 to $4,000 for those over 60, but be reduced for those earning $75,000 or more a year.
The plan would keep Medicaid expansion as it is until 2020, when states would probably have to pick up more of the tab for new enrollees.
The plan also would distribute $100 billion over nine years to states to set up their own health programs, ones that could include additional subsidies to help people pay premiums, copays and deductibles or help finance high-risk pools.
America’s Health Insurance Plans, the nation’s largest trade group of health insurers, sent the chairmen of the Ways and Means and Energy and Commerce committees a letter Wednesday saying it supported the end of several taxes on the industry and changes in the age ratio that determines how much insurers can charge seniors. Currently a plan can charge a senior three times the premium for a younger person, but the Republican plan would make it five times the premium.
But the letter, signed by AHIP CEO Marilyn Tavenner, said insurers would prefer more subsidies go to lower-income individuals and said they preferred a competing GOP plan that would concentrate the subsidies on those earning 200 to 300 percent of the poverty level, as well as adjusting the aid based on a person’s age.
The American Health Care Act provides subsidies to those earning as much as 850 percent of the poverty level.
AHIP also said it is concerned the GOP plan would result in reduced Medicaid funding after 2020, resulting “in unnecessary disruptions in the coverage and care beneficiaries depend on.”
“For example, Medicaid health plans are at the forefront of providing coverage for and access to behavioral health services and treatment for opioid use disorders, and insufficient funding could jeopardize the progress being made on these important public health fronts,” Tavenner said.
A number of GOP conservatives joined Democrats in rejecting the plan, saying it would replace one expensive entitlement program with another.
But House Speaker Paul Ryan, R-Wis., said the GOP will have the votes to pass the bill when it comes to the House floor, probably in two or three weeks.
“We’re going through the inevitable growing pains of being an opposition party to becoming a governing party,” Ryan said.