The Republican bill to repeal and replace Obamacare has passed its first big legislative hurdle, after a combined 44 hours of rancorous committee hearings that began Wednesday morning and stretched through the night into Thursday.
Now that the measure has been advanced by two key House panels, Ways and Means and Energy and Commerce, it will head Wednesday to the House Budget Committee, before getting a full House vote. Between now and then, the Congressional Budget Office is likely to release an estimate of the bill’s cost and coverage, likely feeding the controversy already swirling around the legislation and threatening its demise.
President Trump, Vice President Mike Pence and House Speaker Paul Ryan have been courting House and Senate conservatives this week to support the measure, despite sharp criticisms from nearly every right-leaning advocacy group that the American Health Care Act leaves far too much of Obamacare in place.
Three lawmakers, Reps. Joe Barton, Marsha Blackburn and Richard Hudson, tried in the Energy and Commerce hearing to end the law’s Medicaid expansion two years earlier, in 2018, a move that likely would please many conservatives. But ultimately no changes were made to the legislation after they agreed to withdraw the amendment without a vote.
Instead, most of the discussion in the committee markups centered around Democrats and their many grievances with the legislation. They tried to prolong the process by introducing dozens of amendments that were ruled non-germane or failed to pass.
Members debated many different parts of the law, including how it would halt extra federal Medicaid funding to states, allow more tax deductions for insurer CEO pay, roll back most of the law’s taxes including taxes on tanning beds, and withdraw a preventive health fund that helps finance the Centers for Disease Control and Prevention.
Rep. Diana DeGette, D-Colo., presented an amendment to keep in place Obamacare’s actuarial requirements for plans to cover a certain percentage of services, a part of the law Republicans are seeking to repeal. Eliminating that requirement would cause deductibles to rise even higher, she said.
“Frankly, my colleagues, if you think your deductible is bad under the Affordable Care Act, you just wait to see how high it’s going to go under this new bill,” DeGette said.
Things got heated at points, especially in the second day of the Energy and Commerce markup. Rep. John Shimkus, an Illinois Republican who served in the Army, apologized for expressing anger at Democrats for claiming the bill would hurt veterans.
“I’m embarrassed for you, and I’m embarrassed for your side and I’m embarrassed for your part — to make the accusation we do not care for veterans and use this politically,” Shimkus said.
Democrats were enraged when committee staff admitted that the bill would no longer require Medicaid plans to cover mental health, although Republicans said states could use its $100 billion in innovation funds to help fill that gap.
“Governors are simply not to going to be able to give all of the benefits to those 11 million people that they now are required to get under the Affordable Care Act,” DeGette said, referring to the number of people who got coverage under the Medicaid expansion.
Both of the marathon markups began at 10:30 a.m. Wednesday. Lawmakers on the Energy and Commerce Committee didn’t get to the first vote on an amendment until 12 hours later, prompting frustration from Republicans who said Democrats were spending time on frivolous amendments, such as a proposal to change the bill’s name.
The fate of the Medicaid program was a major part of discussion throughout the night, as the bill would return funding to pre-Affordable Care Act levels for enrollees after 2020. After that, the program would be transformed into a per capita system with federal funding based on how many people sign up in a given state.
While Democrats argued the move would result in fewer people covered, Republicans defended the system, saying it would rein in out-of-control federal spending and give states more flexibility.
“This is not a cut,” said Rep. Brett Guthrie, R- Ky., around midnight. “This is dealing with the growth in Medicaid. This deals with traditional Medicaid as well as the expansion.”
Guthrie added that the bill tries to get “Medicaid on a budget.” Republicans also pointed to support of Medicaid per capita caps in the 1990s, referring to remarks from former President Bill Clinton and former Senate Minority Leader Harry Reid.
But Democrats on the panel balked at the move to per capita caps.
Rep. Gene Green, D-Texas, said Republicans were moving toward the “lesser of two evils,” referring to the other evil as block grants that give a fixed amount to a state.
Rep. Frank Pallone of New Jersey, the top Democrat on the committee, said per capita caps could lead to states dropping people from Medicaid ranks because they have to shoulder more costs.
“Governors can come in and say this cap doesn’t work and we had to kick people off because we couldn’t provide what we provided in the past,” he said.
The measure, dubbed the American Health Care Act, faces many upcoming tests, like whether it will get enough support from House conservatives and Senate moderates, and whether parts of it must be stripped out under Senate rules governing budget reconciliation bills.
But even if some changes must be made to the bill, leadership insists they will be able to get a repeal and replace bill to Trump soon. Ryan has said he wants to hold a House vote before Congress leaves for a two-week Easter break in April. The goal is for Republicans to keep their campaign promises to repeal much of the healthcare law, Ryan said on Fox News on Wednesday night.
“We’re keeping our promises — we’re excited about this,” Ryan said.
