Republican leaders hope that the latest changes to their health care bill win enough votes to drive the legislation through the House later this week. It’s looking tight.
A major goal of the revisions, unveiled late Monday night, is to create more options for older adults dealing with high medical bills, whose costs in many cases would have gone up markedly under the previous GOP bill.
Separately, the bill gives states the option of imposing work requirements for able-bodied older adults on Medicaid.
Highlights of the evolving GOP plan, compared to current law:
To be determined. Under the Obama-era law, about 11 million people are covered by expanded Medicaid in the 31 states that accepted it. Nationwide, an additional 12 million buy private health insurance through government-sponsored markets that offer plans with subsidized premiums. National uninsured rate is below 9 percent, a historic low.
According to the nonpartisan Congressional Budget Office, the original version of the Republican bill would result in 24 million fewer people having health insurance by 2026, compared to Obama’s Affordable Care Act, or ACA.
GOP leaders say updated estimates will be available by the time the legislation goes to the floor. Republicans say the budget office gives too much weight to the unpopular ACA requirement that virtually all Americans have coverage, a mandate dismantled by the GOP bill.
Under the ACA, insurers can charge their oldest customers no more than 3 times what they charge young adults. That benefits older adults prone to illness but has made coverage costly for young people. Tax credits to help pay premiums are keyed to income and the cost of insurance in local communities.
Under the original GOP bill, insurers can charge older customers 5 times what they charge young adults. Tax credits are keyed to age, with people over 60 but still too young for Medicare getting $4,000, which is double what someone under 30 would get.
The latest changes address concerns that older adults, particularly those with lower incomes, will not get enough help.
In an unusual approach, the changes pave the way for the Senate to make the bill’s tax credit more generous for people ages 50-64. Ways and Means Chairman Kevin Brady, R-Texas, said the plan sets aside $85 billion for that purpose.
The changes would also lower the income tax threshold for deducting medical expenses from 10 percent to 5.8 percent.
Under the ACA, states that accept expanded Medicaid receive a generous federal match. The expansion covers people with incomes up to 138 percent of the federal poverty line, or about $16,640 for an individual. Most new beneficiaries are low-income adults with no children at home.
Medicaid is now the country’s largest health insurance program, covering more than 70 million people through a federal-state collaboration. It remains an open-ended entitlement, allowing states to draw down federal money for a portion of health costs incurred by low-income people.
The GOP bill ends the higher federal match for Medicaid expansion beneficiaries. States that already expanded Medicaid can continue to receive some enhanced federal payments, but only for "grandfathered" enrollees already covered.
Of greater significance, the bill would overhaul the underlying framework of Medicaid, ending its open-ended federal financing. Starting with the 2020 budget year, each state would receive a limited, per-beneficiary amount based on enrollment and costs. Federal payments would be increased according to a measure of medical inflation.
In the latest draft, states would also be able to select a block grant to finance their Medicaid programs.
And they would gain the ability to impose work requirements on able-bodied adults. Another change involves more federal money for elderly and disabled Medicaid beneficiaries.
The budget office said the earlier version of the bill would reduce projected federal Medicaid spending by $880 billion from 2017-2026, and 14 million fewer people would be enrolled by 2026.
"OBAMACARE" TAX INCREASES
The new GOP draft would accelerate the repeal of a series of tax increases used to finance the ACA, so that they would be rescinded this year. The ACA’s so-called "Cadillac Tax" on high-cost health plans would be delayed an additional year, to 2026.
NEW YORK MEDICAID
The latest draft limits the ability of New York state to pass Medicaid costs on to its counties. The change, sponsored by Rep. Chris Collins, R-N.Y., an early Trump supporter, would take rural and lower-populations counties off the hook. But New York City would still have to pony up.