Republican leaders were still making deals late Wednesday to possibly change portions of the legislation in order to round up more votes. From MedPage Today.
This article first appeared March 23, 2017 on MedPage Today.
WASHINGTON -- The House Rules Committee adjourned late Wednesday evening without taking the vote needed to send the House Republicans' bill to replace the Affordable Care Act to the House floor for a vote.
Before adjourning the hearing, committee chairman Rep. Pete Sessions (R-Texas) explained to the committee members that it would be hard to vote to send the bill, known as the American Health Care Act, to the House floor because Republican leaders were still making deals with some members to possibly change portions of the legislation in order to round up more votes.
"I had hoped we'd be here with an answer, [but] rather than keeping us here this evening ... we will come back [in the morning] to finish our work," he said. Sessions gaveled the hearing to a close at around 11:30 p.m., after the committee had been in session for 13 1/2 hours.
Democrats on the committee expressed dismay over the way the process was being conducted, although they made it clear that their anger was not directed at Sessions per se. "I just want to say for the record that it is a little bit extraordinary that we find ourselves in this situation," said committee member Rep. Jim McGovern (D-Mass.). "Here we are; it's almost midnight and we [don't] know what we're going to be voting on tomorrow."
"I would urge you to slow down," McGovern said to the Republicans on the committee. "I think the bill as drafted would do great harm to this country -- 24 million people would lose their health insurance, and millions more would lose their healthcare protections. I would strongly urge that we go back to the drawing board."
Among other things, the bill would halt the Medicaid expansion program started under the ACA, freezing new enrollment after 2 years while grandfathering in current enrollees. It would keep some provisions of the ACA, including a ban on discriminating against patients with pre-existing conditions and allowing children to stay on their parents' plans to age 26.
The bill would replace the current federal Medicaid contribution with a "per-capita cap" system, under which states would be given a set per-capita amount of money for each Medicaid enrollee. Under the current Medicaid program, the federal government gives states matching funds based on each state's Medicaid spending; poorer states receive a larger Medicaid match.
The committee heard testimony Wednesday evening on a number of proposed amendments to the bill, including:
- An amendment that would allow veterans not enrolled in the Veterans Administration (VA) healthcare system to receive tax credits toward the purchase of private health insurance. "There is a 'manager's amendment' [being proposed] which would ... deny veterans access to the tax credits they would have received had they not served in the defense of this country," said Rep. Mark Takano (D-Calif.). "We know that 9 million veterans are not enrolled in the VA's care now ... This [amendment] appears to exclude all of them from receiving tax credits to pay for healthcare. For all this talk I hear about giving veterans [healthcare] choices, it's disappointing and frustrating that the majority would support a bill that limits the options veterans have to get the care they need."
- An amendment that would exempt children enrolled in Medicaid -- including those with special needs -- from the per-capita cap calculation. "If it is applied to all children, my concern is that the cap could create a large shortfall, more particularly among these vulnerable populations," said Rep. Jaime Herrera Beutler (R-Wash.), who is the parent of a special needs child. "These kids are living longer and their quality of life is expanding; that's a great, great challenge to have. We need to make sure we're calculating [their costs] right ... I'm concerned that a reduction could put children's access to healthcare at risk."
- An amendment that would freeze the Medicaid expansion enrollment earlier than originally proposed, thereby decreasing the extra federal funds that go to expansion enrollees; the federal government currently pays 90-95% for this Medicaid group -- which includes childless adults -- instead of the traditional Medicaid matching amount, which is around 57% depending on the state. "I don't think under any circumstances there's any program where we should be giving states 90% of the cost of something. It's just an invitation to irresponsibility," said Rep. Glenn Grothman (R-Wisc.). "Right now the expansion continues to the end of [2019]; this amendment makes it to the end of [2018]; quite frankly, if I had an expansion state, I'd want to phase it out earlier, because the longer it drags on the more it becomes an expectation."
Committee Democrats noted that while the hearing was continuing, stories were circulating that among the changes Republican House leaders were offering recalcitrant members was a proposal to get rid of the ACA's requirement that all health plans must offer certain "essential" health benefits, such as maternity care and emergency care. "It seems the chatter is that those are the areas that will be targeted, and we think that will make a very bad bill even worse," said McGovern.