WASHINGTON _ After months of negotiations, House Republicans Monday released their long-awaited legislation to repeal and replace the Affordable Care Act.
The House Energy and Commerce Committee and the House Ways and Means Committee are expected to move quickly, taking up the measure at hearings Wednesday, which would set the stage for the proposals to be merged into a final bill next week by the House Budget Committee.
The legislation hasn't been scored by the Congressional Budget Office for its cost and impact. But most experts expect fewer people to get coverage under the plan than under President Barack Obama's Affordable Care Act.
Senate Republicans are hoping to vote on the measure before the end of March, but four Republican senators _ Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner or Colorado and Lisa Murkowski of Alaska _ told Senate Majority Leader Mitch McConnell Monday that previous House drafts would not provide enough support for newly eligible Medicaid enrollees who gained coverage under the Obama's law.
If those four Republicans withhold support for the proposal, the bill would have a tough time getting the 60 votes needed to pass it.
Under the Affordable Care Act, federal subsidies, or tax credits, help more than 80 percent of marketplace enrollees purchase health insurance. The amount of the tax credit is based on income and the cost of coverage, but generally, the lower the income, the higher the tax credit. People who earn more than four times the poverty rate don't even qualify for tax credits under the law. They must pay the full cost of coverage.
Republicans would offer a similar tax credit to all who purchase individual insurance, based on age and income and adjusted annually for inflation.
The bill also would continue the current law's requirement that insurers provide access to coverage for all, even those with pre-existing medical conditions. But insurers could charge 30 percent more for coverage to plan members who let their insurance lapse.
Upon releasing the legislation, House Energy and Commerce Committee Chairman Greg Walden, R-Ore., said it is an important step in making good on Republican efforts to repeal the Affordable Care Act.
"We've spent the last eight years listening to folks across this country, and today we're proud to put forth a plan that reflects eight years' worth of those conversations with families, patients, and doctors," Walden said in a statement. "We are moving forward united in our efforts to rescue the American people from the mess Obamacare has created."
Rep. Justin Amash, R-Mich., a member of the conservative Freedom Caucus, derided the bill on social media minutes after it was introduced. He referred to it as "Obamacare 2.0."
Polls increasingly showed in recent weeks that the Affordable Care Act has become more popular. A McClatchy-Marist poll in February found little support for repealing it. Fifty-eight percent of those polled either wanted the law to stay in place, or changed so it would do more.
Republican members of Congress wanted the tax credits to go to all who purchase individual insurance, both in and outside the insurance marketplace. But faced with concerns that the plan would provide an entitlement to the wealthy, Republicans have proposed reducing the tax credit for individuals who earn more than $75,000 and for joint-income filers who earn more than $150,000.
Tax credits for those earning more than that amount would decline by $100 for each $1,000 in income, Republican staffers said.
Plan members in their 20s would get tax credits in the $2,000 range. Those in their 30s would get roughly $2,500 and people in their 40s would get roughly $3,000. People in their 50s would receive tax credits of about $3,500 and those over 60 would get roughly $4,000.
Most of the proposal comes as advertised: It calls for ending income-based federal subsidies to help purchase marketplace coverage and would wipe out all taxes that helped pay for the subsidies.
The proposal also would end the individual mandate that requires all Americans to have health coverage, and would end the employer mandate that requires certain employers to provide health insurance benefits. It also would phase out federal funding for newly eligible Medicaid-expansion enrollees and would provide more money for states to cover people with costly medical conditions through high-risk pools.
Critics say the measure would also restrict women's access to health care by withholding federal funding for groups that perform abortions, including Planned Parenthood.
The legislation would also eliminate funding beginning in 2019 for the Prevention and Public Health Fund, which provides grants to state and local health departments through the Centers for Disease Control and Prevention.
The proposal also calls for repealing the Affordable Care Act's Medicaid expansion. It would allow states that expanded Medicaid a limited time to continue the enhanced federal funding for their newly eligible recipients _ no less than 90 percent of their medical costs.
Eventually, those enrollees would be funded at the basic Medicaid level, forcing states to bear more of their costs or to limit their eligibility for Medicaid.
The bill would also change Medicaid's funding formula to a "per capita cap" system.
Currently, the federal government pays a share of each state's Medicaid spending _ from 50 to 80 percent _ with no limit on total costs.
A per capita cap would provide funds for each Medicaid beneficiary in certain groups _ like pregnant mothers, the disabled and children _ up to a specified amount. Doing so would end Medicaid's guarantee of coverage for all who qualify and would require restructuring program eligibility and coverage rules.
The Republican bill would also resurrect high-risk pools to provide coverage for hard-to-insure plan members.
In 35 states, 226,000 people who were unable to get private insurance before the Affordable Care Act were covered through state high-risk pools, a program for the medically uninsurable.
Under the current law, premiums for sicker, costlier consumers are supposed to be held down because they're part of a pool of covered individuals that includes healthier people.
The plan would retain the Affordable Care Act's list of benefits that all policies must provide. But it would end coverage "metal tiers," which rate the quality of coverage through Bronze, Silver, Gold and Platinum plans. Instead, states will set guidelines for determining the quality of coverage.
Democrats criticized [the secretive nature of the bill's beginnings and its contents.
"The Republican repeal bill would rip health care away from millions of Americans, ration care for working families and seniors, and put insurance companies back in charge of health care decisions _ contrary to everything President Trump has said he would do with his health care plan," Democratic Reps. Frank Pallone of New Jersey and Richard Neal of Massachusetts said in a joint statement after the bill was made public. Pallone and Neal are the ranking Democratic members of the two committees that will mark up the bill Wednesday.
