In a letter to Senate Majority Leader Mitch McConnell on Monday, Republican Sens. Rob Portman, Shelley Moore Capito, Cory Gardner, and Lisa Murkowski laid out concerns regarding the repeal and replacement of the Affordable Care Act, in what could be the beginning of serious trouble for the GOP's plan to overhaul the healthcare law.

The four senators wrote that they were specifically concerned with the leaked draft version of the House GOP's Obamacare repeal and replacement bill as it pertains the expansion of the federal Medicaid program.

Under Obamacare, states were allowed to expand their Medicaid program to include Americans that make up to 137% of the federal poverty line. So far, 34 states and the District of Columbia took funding from the federal government to expand the program, leading to coverage for over 11 million people who otherwise would not have had insurance.

The senators wrote they were concerned that the changes to funding in the leaked House legislation would leave states stretched to keep such people covered. All four senators come from a state that has expanded Medicaid.

"While we support efforts to repeal and replace the Affordable Care Act and make structural reforms to the Medicaid program, we are concerned that the February 10th draft proposal from the House of Representatives does not provide stability and certainty for individuals and families in Medicaid expansion programs or the necessary flexibility for states,"the letter to McConnell said.

The House GOP bill would shift the current funding structure and would put more of the funding onus on the states, which may be difficult to sustain given already stretched state budgets.

In the letter, the senators advocated for more "flexibility" for states that want to expand Medicaid and urged a longer timeframe for the transition of Medicaid programs.

"As the largest payer of mental health and substance use services in the United States, it is critical that any healthcare replacement provide states with a stable transition period and the opportunity to gradually phase-in their populations to any new Medicaid financing structure," the senators wrote.

The senators suggested they would not support the draft plan in its current form. It would represent a significant blow to GOP efforts to repeal and replace the law, as the loss of four votes would almost certainly kill Republican efforts to pass legislation.

"However, the February 10th draft proposal from the House does not meet the test of stability for individuals currently enrolled in the program and we will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states,"the letter said.

In another sign of worry for GOP leadership, three more conservative-leaning GOP senators — Rand Paul, Ted Cruz, and Mike Lee — have pledged to vote against the House GOP bill because it does not go far enough in repealing the ACA. If those three senators vote against the bill, it would also out the GOP under the 50-vote threshold absent Democratic defections.

SEE ALSO: Paul Ryan's plan to repeal and replace Obamacare is expected to come out soon — here are the biggest fights he'll face

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House Republicans on Monday evening unveiled long-awaited legislation to repeal and replace the Affordable Care Act, the healthcare law better known as Obamacare.

The basic structure of the plan appears similar to previous Republican efforts to dismantle the law including the draft of the bill that was leaked late last month.

The bill, called the American Health Care Act, would do away with Obamacare's individual mandate that compels all American to buy insurance or face a fine. Instead, it features penalties such as increased premiums for failing to maintain continuous coverage.

The AHCA also would shift funding for people accessing healthcare without help from an employer or the Medicare or Medicaid programs and adjust funding for the expansion of Medicaid.

Key parts of the bill include:

• Allowing people with preexisting conditions to access coverage but penalizing lapses in coverage: Under the new law, insurers still could not deny coverage based on a preexisting condition, but anyone who does not have coverage for a period of 63 days or more in the previous year is subject to a 30% increase in premiums as a penalty. The idea would be to discourage people from waiting until they are sick to access coverage.
• Introducing block tax credits for individuals to access health insurance: Instead of the ACA's tax credits, which adjusted the amount distributed based on income and the beneficiary's residence, the AHCA would give lump tax credits to Americans. The credits would be based on age, and an individual making over $75,000 or a household making over $150,000 a year would see a decrease in the credit depending on how much he or she made over that limit. Here's the breakdown of how much each age group would get:
• Under 30: $2,000 a year
• Age 30 to 39: $2,500 a year
• Age 40 to 49: $3,000 a year
• Age 50 to 59: $3,500 a year
• Age 60 and above: $4,000 a year
• Providing grants to establish high-risk pools and encourage enrollment: Much as with the leaked draft, the AHCA would include a fund for states to institute numerous programs to stabilize the insurance market, most notably "the provision of financial assistance, high-risk individuals who do not have access to health insurance coverage offered through an employer." This would allow states to establish high-risk pools for people with preexisting conditions, a plan often floated by Republicans. The plan would give states $15 billion in both 2018 and 2019 and $10 billion every year after that through 2026.
• Changing the limit that insurers can charge older customers compared with younger customers: Under the ACA, insurers can charge older customers (generally sicker and more expensive to cover) no more than three times what they charge their youngest customers (generally healthier). The Republican bill would shift that to five times the amount.
• Effectively defunding Planned Parenthood: The bill prohibits "direct spending" of federal dollars on any "prohibited entity" including those that provide abortions for anything other than the life of the mother, incest, or rape. This would seem to include Planned Parenthood.
• Kick lottery winners off of Medicaid: The bill spends six pages detailing instances in which a person who receives a lump sum or large payments from winning the lottery would be kicked off of Medicaid.

President Donald Trump was quick to dive in with a tweet from the @POTUS account.

"House just introduced the bill to #RepealAndReplace #Obamacare. Time to end this nightmare,"the tweet said.

House Speaker Paul Ryan said in a statement that the plan would help reform the American healthcare system.

"The American Health Care Act is a plan to drive down costs, encourage competition, and give every American access to quality, affordable health insurance," Ryan said. "It protects young adults, patients with preexisting conditions, and provides a stable transition so that no one has the rug pulled out from under them."

On the other end, Democrats were quick to criticize the proposal. Reps. Frank Pallone and Richard Neal, the top Democrats on the House Energy and Commerce Committee and the Ways and Means Committee, respectively, said in a joint statement that the bill would be detrimental to average Americans.

"The Republican repeal bill would rip healthcare away from millions of Americans, ration care for working families and seniors, and put insurance companies back in charge of healthcare decisions — contrary to everything President Trump has said he would do with his healthcare plan," the statement from Pallone and Neal said.

The bill faces a long path toward becoming law: It would have to be marked up by the Energy and Commerce Committee, passed by the House, debated by the Senate, and passed by the Senate, at least, before it could go to Trump's desk.

This path is also complicated by the fact that conservative members of the House and the Senate have come out against the tax-credits aspects of the House bill and criticized the leaked draft. Moderate Republicans have also criticized the lack of clarity over the future of Medicaid expansion, which is popular in states that have undertaken expansion.

Thus, the bill released the House GOP may face significant opposition from the Republican Party itself, to say nothing of the Democrats.

Here's the full bill:

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The House Republican leadership dropped their plan to repeal and replace Obamacare, called the American Health Care Act, on Monday.

While the plan laid out the repeal of the Affordable Care Act, changes to Medicaid expansion, and more, one detail was missing: how the changes are paid for.

The bill repeals many taxes associated with the ACA, even down to a tax on tanning bed parlors, but still provides tax credits to people to buy insurance and $15 billion in funding for states to develop insurance market solutions like high-risk pools.

With continued expenses and few sources of funding in the law, some analysts wondered how the House GOP plans to pay for the law.

The House GOP's question and answer page on the AHCA did not provide many more details.

"How are you paying for this plan? How much is it going to cost taxpayers?"reads the House GOP page on the plan.

"We are still discussing details, but we are committed to repealing Obamacare and replacing it with fiscally responsible policies that restore the free market and protect taxpayers."

That's it.

This will likely not please some conservative Republicans.

Sen. Rand Paul has repeatedly expressed concerns about how much an Obamacare replacement plan would add to the federal deficit. Paul, along with Sens. Ted Cruz and Mike Lee, said that they would vote against a plan that looked like the leaked draft of the House GOP's plan in part over fiscal concerns.

The details in the bill and the House GOP's website do not appear to soothe any of these concerns.

SEE ALSO: Republicans have released their long-awaited plan to repeal Obamacare

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House Republicans unveiled their Affordable Care Act (ACA) replacement plan on Monday — called the American Healthcare Act (AHCA). People on social media were quick to compare the two plans in a series of illustrative photos.

As Business Insider's Bob Bryan reported earlier Monday, the AHCA would do away with Obamacare's individual mandate that compels all American to buy insurance or face a fine.

Instead, it features penalties such as increased premiums for failing to maintain continuous access to coverage.

The AHCA also would shift funding for people accessing healthcare outside of an employer or Medicare/Medicaid programs and adjust funding for the expansion of Medicaid.

Twitter users reacting to the GOP's Obamacare replacement expressed how they felt about it with a series of comparative photos. You can see some of them below:

You can see other ACA vs. ACA replacement tweets here»

And the full 123-page American Healthcare Act can be read here»

SEE ALSO: The House GOP plan to repeal and replace Obamacare would effectively defund Planned Parenthood

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NOW WATCH: 'I would be dead if it weren't for him': A man who says Obamacare saved his life confronts Paul Ryan on repealing the law

House Republican leadership's rollout of a plan to repeal and replace the Affordable Care Act (ACA) was met with sharp resistance Tuesday from conservative lawmakers and influential conservative-leaning groups, putting the future of the legislation in immediate doubt even as President Donald Trump's administration signaled approval.

Hard-line conservatives who have vowed to fully repeal Obamacare voiced concerns with the GOP's attempt to repeal and replace it, signaling they feel it doesn't go far enough.

Rep. Mark Meadows, head of the influential conservative House Freedom Caucus, told Fox News' Sean Hannity that the AHCA "sets a new entitlement, keeps some taxes, doesn’t repeal all of Obamacare."

"We’ve got to do better, and hopefully with some new amendments we can do that," Meadows said.

In the same interview with Hannity, Rep. Louie Gohmert, a conservative firebrand who is not a part of the House Freedom Caucus, criticized the bill and said he had already heard concerns from constituents.

The House Freedom Caucus is expected to hold a press conference at 3:30 p.m. ET to lodge complaints about the bill. If all Democrats vote their party line, the House GOP could not afford to lose the Freedom Caucus membership.

And the Republican Study Committee — a conservative caucus with 172 members — released a memo criticizing the AHCA as well, specifically the tax credits proposed for people to buy healthcare if they do not receive it from their employer or a government program like Medicare or Medicaid.

"Writing checks to individuals to purchase insurance is, in principle, Obamacare," said the memo, which went on to criticize the cost of the credits.

The RSC memo also attacked the fact that the new bill will allow the ACA's Medicaid expansion to last until 2020, saying it will continue to "contribute to the worsening of the federal and state budgets."

Other Congressional Republicans were more aggressive in their criticisms of the legislation, which has been spearheaded by the heads of the House Ways and Means and House Energy and Commerce committees with the support of top leaders like House Speaker Paul Ryan. Rep. Justin Amash, a longtime critic of Obamacare and House Freedom Caucus member, tweeted that the AHCA was "Obamacare 2.0."

And Sen. Rand Paul — who has been railing against the House plan since a draft of the bill was leaked — tweeted on Tuesday that he did not support the House GOP plan.

"House leadership plan is Obamacare Lite," Paul tweeted. "It will not pass. Conservatives are not going to take it."

GOP Sen. Roy Blunt of Missouri told a local radio station that the bill may not get enough votes to make it past the Senate, according to CNN's K-File.

"What I don't like is it may not be a plan that gets a majority votes and let's us move on,"said Blunt."Because, we can't stay where we are with the plan we've got now."

Sen. Mike Lee of Utah, who came out against the leaked draft bill along with Paul and Sen. Ted Cruz, also released a press release criticizing the Hose GOP bill.

"This is not the Obamacare repeal bill we’ve been waiting for,"said Lee."It is a missed opportunity and a step in the wrong direction."

Key conservative-leaning advocacy groups also came out skeptical of the bill. Heritage Action of America, the advocacy arm of the influential conservative Heritage Foundation think tank, also came out against the AHCA in a statement on Tuesday.

"Many Americans seeking health insurance on the individual market will notice no significant difference between the Affordable Care Act (i.e., Obamacare) and the American Health Care Act,"said the statement from Heritage Action CEO Michael Needham. "That is bad politics and, more importantly, bad policy."

Other conservative groups, including Club for Growth, Freedom Partners, and Americans for Prosperity have also come out against the bill. Club for Growth even dubbed the plan "Ryancare," a nod to the House speaker.

Michael Cannon, the director of conservative think tank Cato Institute's health policy studies, also attacked the bill in a column on Tuesday calling it "a train wreck waiting to happen" and saying it does not repeal enough of the ACA.

"Obamacare would consume the rest of Congress’ and President Trump’s agenda," wrote Cannon. "Delaying or dooming other priorities like tax reform, infrastructure spending, and Gorsuch. The fallout could dog Republicans all the way into 2018 and 2020, when it could lead to a Democratic wave election like the one we saw in 2008."

In an interview with "Fox and Friends," Paul also criticized a provision in the AHCA that allows insurance companies to charge people who do not maintain continuous health-coverage premiums up to 30% more than if they had kept coverage. Paul said that instead of Obamacare's individual mandate, in which a consumer who does maintain coverage pays the government a penalty, this provision would amount to a mandate that benefited insurers and is "likely unconstitutional."

"So much of their bill is a bail out for the insurance companies," Paul said.

On the other end, four GOP senators wrote a letter before the release of the House GOP's bill, saying they would not support the leaked draft of the bill because of its inadequate protections of the ACA's Medicaid expansion. The expansion has allowed 11 million people to access health insurance and has become popular in states that have expanded coverage.

While these senators have not commented on the new bill yet, the AHCA does not make many major changes to the leaked memo's Medicaid expansion phase-out, which would end the current federal funding program in 2020 and shift funding to a per-capita program in 2020 that experts say would most likely be less generous.

SEE ALSO: Republicans have released their long-awaited plan to repeal Obamacare

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NOW WATCH: 'It's a lie': Jake Tapper calls out Trump during a fiery interview with Kellyanne Conway

President Donald Trump used Twitter early Tuesday morning to praise the new House GOP bill to repeal and replace the Affordable Care Act, the healthcare law better known as Obamacare.

Trump called the American Health Care Act, released Monday, a "wonderful new Healthcare Bill" and attacked Obamacare.

"Our wonderful new Healthcare Bill is now out for review and negotiation," Trump tweeted. "ObamaCare is a complete and total disaster — is imploding fast!"

The bill has already drawn criticism from Democrats and many conservative Republicans, albeit for very different reasons.

Trump also tweeted directly to the Fox News morning show "Fox and Friends," whose anchors were discussing the plan shortly before the tweet. The president promised future changes to healthcare, including allowing insurers to sell plans across state lines, in what he called "phase 2 & 3" of his healthcare overhaul.

"Don't worry, getting rid of state lines, which will promote competition, will be in phase 2 & 3 of healthcare rollout. @foxandfriends," Trump tweeted.

The plan to allow insurance plans that are accredited in one state to be sold in all others has long been a Republican goal and was one of Trump's five key policy proposals in his speech to Congress. It was, however, conspicuously absent from the AHCA.

Additionally, most health-policy experts say that a similar provision already exists in the ACA and no insurers have taken advantage of it and that it is unlikely to improve cost or competition for insurance plans.

Here are the tweets:

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Rep. Jason Chaffetz attempted to sell the new Republican healthcare plan on Tuesday by asking Americans to purchase health insurance instead of buying an iPhone.

Appearing on CNN's "New Day," the Utah Republican dismissed questions about whether fewer Americans would be covered by the GOP's replacement of the Affordable Care Act, better known as Obamacare.

"Americans have choices, and they've got to make a choice. So maybe rather than getting that new iPhone that they just love and they want to go spend hundreds of dollars on that, maybe they should invest in their own healthcare," Chaffetz said. "They've got to make those decisions themselves."

Chaffetz did not answer whether the new GOP plan would require lower-income Americans to make sacrifices, but he said that "with more choice, you will get a better product at a lower price."

Some observers said that while a new iPhone without a contract rarely costs more than $600, the US healthcare system costs more than $10,000 per person on average every year. This number can be slightly misleading, as spending varies wildly among people, with just 5% of the population accounting for half of all healthcare spending.

Appearing on Fox News later Tuesday morning, Chaffetz expressed slight regret about his choice of words but stood by the sentiment that Americans needed to prioritize their health insurance.

"Maybe I didn't say that as smoothly as I possibly could," he said. "But people need to make a conscious choice, and I believe in self-reliance, and they're going to have to make those decisions.

"Sometimes you have to make some decisions in your life and where to make those investments," he added.

He pointed to the bill's proposed elimination of Obamacare's individual mandate, which requires people who would not end up paying more than 8% of their monthly income for health insurance to purchase the minimum policy or face tax penalties. The plan would also eliminate the mandate requiring large employers to offer coverage to full-time employees. The individual mandate was designed to compel Americans to seek health insurance while ensuring that the markets weren't flooded with sicker people, which drives up the cost of insurance.

Instead of complying with the individual mandate, insurance companies would be allowed under the GOP plan to charge 30% higher premiums for people who had gone 63 days without health insurance.

The plan, which the House released on Monday, would make several changes to the current law, such as eliminating taxes on higher-income earners as well as income-based tax credits and the Medicaid expansion that many states have adopted. Instead, the plan would create per-capita caps for Medicaid and new refundable tax credits for several age groups.

The proposal would keep some popular Obamacare initiatives in place, such as allowing Americans up to age 26 to stay on their parents' healthcare plans.

But it also would tweak other portions, such as allowing insurance companies to charge older Americans five times as much as what younger Americans pay. Obamacare permits insurers to charge three times as much as what younger Americans pay.

Chaffetz's comments immediately drew criticism from some Democrats.

"Jason Chaffetz and Donald Trump want to cut healthcare coverage for low-income Americans to pay for tax breaks for wealthy insurance company executives," Shripal Shah, the vice president of the Democratic PAC American Bridge, said in a statement. "To make matters worse, Chaffetz, whose own healthcare is taxpayer-subsidized, is so out of touch with working Americans that he doesn't realize the healthcare cost burden shouldered by his constituents isn't as trivial as the price of a new cellphone."

The plan itself has faced almost universal opposition from congressional Democrats, and some conservatives are wary of it.

Sen. Rand Paul, Republican of Kentucky, argued that the proposal would not do enough to drive down costs.

Watch a clip of Chaffetz, via CNN:

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Healthcare stocks are down after House Republicans rolled out their new healthcare plan, called the American Health Care Act (AHCA), to replace Obamacare or the Affordable Care Act (ACA) on Monday.

The Health Care Select Sector SPDR Fund which tracks the sector's performance is down 0.7% at 9:56 a.m. ET on Tuesday.

In contrast to the general index, healthcare stocks have had a relatively bumpy ride since the election—underperforming the S&P 500 index from the election until January 1 but have recorded the second-best sectoral gains since then.

Here's a rundown of the biggest losers among healthcare stocks on Tuesday at 9:53am ET:

Tenet Healthcare: -3% @ $20.18

HCA Holdings: -0.5% @ $87.38

Universal Health Services:  -1.3% @ $124.98

Lifepoint Hospitals: -0.1% @ $64.75

United Health Group: -0.1% @ $168.58

Aetna is outperforming its peers, trading up 0.4% at $131.86 per share. 

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Health and Human Services Secretary Tom Price, the top healthcare official in President Donald Trump's Cabinet, expressed support for the House GOP's new plan to repeal and replace the Affordable Care Act in a letter to congressional Republican leaders on Tuesday.

Price, a former Republican representative from Georgia and surgeon, said the new plan — called the American Health Care Act (AHCA) — will "align with the President's goal of rescuing Americans from the failures of the Affordable Care Act."

"These proposals offer patient-centered solutions that will provide all Americans with access to affordable, quality healthcare, promote innovation, and offer peace of mind for those with pre-existing conditions,"Price wrote in the letter to the two House leaders in charge of the committees that will review the bill, Ways and Means Chair Rep. Kevin Brady and Energy and Commerce Chair Rep. Greg Walden.

The AHCA does conform to the principles laid out by Trump in his joint address to Congress, but it notably omits some ideas favored by the president, including allowing the sale of insurance plans across state lines and controls for prescription drug costs.

Trump tweeted Tuesday morning that those elements are coming in "phase 2 & 3" of the healthcare overhaul.

House Speaker Paul Ryan tweeted that the letter was "GREAT NEWS" and Price "endorsed our bill to repeal & replace Obamacare on behalf of the Trump administration."

Here's the full letter:

THE SECRETARY OF HEALTH AND HUMAN SERVICES WASHINGTON, D.C. 20201
March 7, 2017

Hon. Greg Walden Chairman Committee on Energy & Commerce 2125 Rayburn House Office Building Washington, DC 20515

Dear Chairman Walden and Chairman Brady:
Hon. Kevin Brady Chairman Committee on Ways & Means 1102 Longworth House Office Building Washington, DC 20515

On behalf of the Trump Administration, I am writing in support of the reconciliation recommendations recently released for consideration by your Committees. Together, they align with the President's goal of rescuing Americans from the failures of the Affordable Care Act. These proposals offer patient-centered solutions that will provide all Americans with access to affordable, quality healthcare, promote innovation, and offer peace of mind for those with pre-existing conditions.

Your legislative proposals are consistent with the President's commitment to repeal the Affordable Care Act; provide advanceable, refundable tax credits for Americans who do not already receive such tax benefits through health insurance offered by their employers; put Medicaid on a sustainable path and remove burdensome requirements in the program to better target resources to those most in need; empower patients and put healthcare dollars and decisions back into their hands by expanding the use of health savings accounts; ensure a stable transition away from the Affordable Care Act; and protect people with pre-existing conditions.

Achieving all of the President's goals to reform healthcare will require more than what is possible in a budget reconciliation bill, as procedural rules on this type of legislation prevent inclusion of key policies such as selling insurance across state lines, lowering drug costs for patients, providing additional flexibility in Medicaid for states to manage their programs in a way that best serves their most vulnerable citizens, or medical legal reforms. Your proposals represent a necessary and important first step toward fulfilling our promises to the American people. We look forward to working with you throughout the legislative process, making necessary technical and appropriate changes, and ensuring eventual arrival of this important bill on the President's desk.
Yours truly,

Thomas E. Price, M.D. Secretary

SEE ALSO: TRUMP: 'Phase 2 & 3' of 'wonderful' healthcare overhaul will come soon

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After the rollout of the House GOP plan to repeal and replace the Affordable Care Act, also known as Obamacare, many health policy experts and lawmakers scrambled to address just how the new bill would impact coverage for everyday Americans.

The new plan, called the American Health Care Act (AHCA), would roll back funding for the ACA's Medicaid expansion and shift the tax credits that help Americans pay for health insurance.

One effect of the proposals on which many health policy experts — and even some Republicans — agree is that the AHCA will result in a lower total number of people covered than under the current system.

Many health policy experts said the bill, if enacted, would lead to a significant number of Americans losing their coverage. 

"Reading through the House GOP bill, it's hard to imagine the coverage loss is any less than 15 [million] versus the ACA,"tweeted Loren Adler, associate director of the Schaeffer Initiative for Innovation in Health Policy at the Brookings Institution.

Larry Levitt, senior vice president at nonpartisan Kaiser Family Foundation, agreed with this assessment.

"With Medicaid reductions and smaller tax credits, there's no way the House GOP bill covers as many people as the ACA,"Levitt said.

Those assessments could present a major conflict with President Donald Trump's previous vows to present a plan that would cover "everyone." So far, Trump's top health official, Secretary of Health and Human Services Tom Price, has said that the administration supports the bill, but also called it a first step.

As Kaiser broke down, the block credits for insurance proposed in the legislation, ranging from $2,000 annually for people under age 30 to $4,000 for those over age 60, would amount to far less than the credits under the ACA and would likely lead to people forgoing coverage to avoid the higher cost. In addition, the current funding structure for Medicaid expansion would be repealed as of 2020. The expansion has led to coverage for more than 11 million Americans that would otherwise not have insurance.

Republican Rep. Jason Chaffetz told CNN's New Day that it was "fair" to say that the plan will provide more access but less overall coverage, though he said lawmakers are sill "consuming" the elements of the law.

Rep. Kevin Brady — the head of the House Ways and Mean Committee and a key architect of the law — dodged reporter questions on whether the law would cover as many people, instead saying that the law would provide "access" to Americans.

The use of "access" over the guarantee of coverage has long been a Republican argument. The GOP has long touted "access" to insurance rather than promising increased coverage. A report from Bloomberg before the bill was released said that Republican lawmakers and staffers were aware that their plan would likely result in lower coverage totals overall.

This, however, may be a feature, not a bug, as many Republicans have said the mandate from the ACA was forcing Americans who did not want coverage into getting insurance, a point echoed by Chaffetz.

"Well, we're getting rid of the individual mandate. We're getting rid of those things that people said that they don't want," said Chaffetz on CNN. "So maybe instead of getting that new iPhone that they just love and they want to go spend hundreds of dollars in that, maybe they should invest in their own healthcare."

SEE ALSO: 'Obamacare 2.0': Conservatives are already revolting against the House GOP's Obamacare plan

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With the House GOP leadership's new healthcare bill facing a growing tide of conservative backlash Tuesday, its top proponents fought back with a catchphrase of their own.

The bill, the American Health Care Act, has already come under siege from conservative members of the GOP and a large number of right-leaning groups. The chief criticism stems from the belief that the AHCA does not go far enough to repeal its predecessor, the Affordable Care Act, better known as Obamacare, instead keeping things like tax credits for people to buy insurance.

The Cato Institute and the Club for Growth are among conservative groups that have criticized the bill, while Sen. Rand Paul has referred to it as "Obamacare Lite."

To push back, GOP leaders in the House of Reprsentatives and the White House have seemingly tested out a catchphrase for their plan: "Obamacare gone."

Rep. Kevin Brady, the chair of the Ways and Means Committee and an architect of the AHCA, used the phrase during a press conference.

"This is Obamacare gone," Brady said. "This is the first and most important step to giving relief to Americans from this terrible law."

Vice President Mike Pence also used a variation of the line, saying in a radio interview that the bill meant "Obamacare done."

The AHCA's initial rollout has faced a large wall of resistance, with Democrats roundly rejecting the bill along with the strong conservative pushback. The bill will still need to be marked up by the House committees before making it to the full floor for a vote.

SEE ALSO: 'Obamacare 2.0': Conservatives are already revolting against the House GOP's Obamacare plan

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Health and Human Services Secretary Tom Price said Tuesday that the new House GOP plan to overhaul the American healthcare system would bring down the cost of premiums and the cost of healthcare in the US while not increasing the federal deficit.

"We believe strongly that through this process and as it takes effect, that we will see a decrease in not only the premiums that individuals will see but a decrease in the cost of healthcare for folks," Price said, appearing at the White House press briefing.

Price's promises about the House Republican proposal, which has already run into intraparty criticism, will be difficult to keep.

That's because total healthcare spending — based on the Centers for Medicare and Medicaid Services' National Health Expenditure Account — has never gone down year-over-year since 1961, increasing be an average of 9.1% annually over that time.

Additionally, the period of time following the passage of the Affordable Care Act saw the annual increase in healthcare expenditures slow to its lowest level since the data began, with an only 2.9% increase in 2012.

Finally, premiums have similarly been increasing for years — and, under the ACA, have slowed their rise.

From 2001 to 2006, average monthly premiums for family of four increased by 63%. From 2006 to 2011, that number fell to 31%. And from 2011 to 2016, there was an increase of 20%, according to an analysis by the nonpartisan Kaiser Family Foundation.

Premiums have not decreased on a year-over-year basis since at least 2000.

Price also said that the "goal and desire" of Republicans is that the AHCA would not increase the federal deficit. Such a goal comes despite the fact that it keeps large payments for insurance while also repealing taxes that helped pay for those expenses.

"I know the goal and desire of those on the hill is that this does not increase the cost to the federal government," Price said.

The Joint Committee on Taxation, a nonpartisan congressional analysis office, estimated in a release Tuesday that the AHCA would lose roughly $500 billion in revenue for the federal government over the next decade.

SEE ALSO: The Republican plan on Obamacare will likely lead to many Americans losing health insurance

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Rep. Jason Chaffetz attempted to sell the new Republican healthcare plan on Tuesday by asking Americans to purchase health insurance instead of buying an iPhone.

Appearing on CNN's "New Day," the Utah Republican dismissed questions about whether fewer Americans would be covered by the GOP's replacement of the Affordable Care Act, better known as Obamacare.

Join the conversation about this story »

Republican members of Congress held a press conference on Tuesday to denounce their party leadership's American Health Care Act and said they would introduce their own Obamacare-repeal plan on Wednesday.

Members of the House Freedom Caucus and Republican senators suggested the proposed legislation did not go far enough in repealing all the taxes and entitlements in the Affordable Care Act.

"We think you have to get rid of Obamacare completely, so tomorrow I will introduce the bill that every single Republican voted on just 15 months ago, the bill that actually repeals Obamacare," Rep. Jim Jordan of Ohio said.

Jordan said he would introduce a bill similar to the bill that was passed by Congress in 2015 to repeal the ACA. That bill was vetoed by former President Obama.

Sen. Rand Paul and Sen. Mike Lee, who have also criticized the AHCA for not going far enough, were also present at the press conference. Paul said the GOP is united on repeal but "divided on a replacement," so the party should do a "complete repeal" of the ACA and work on crafting a replacement later.

"There's one thing that has united Republicans in when we won the House, in 2014 when we won the Senate, and in 2016 when we won the White House. This doesn't divide Republicans, this brings us together, and that is complete repeal, clean repeal," Paul said.

President Trump responded to Paul's criticisms in a tweet on Tuesday night, saying that the senator will come around to the plan.

"I feel sure that my friend @RandPaul will come along with the new and great health care program because he knows Obamacare is a disaster!"tweeted Trump.

The AHCA has faced serious criticism since it was introduced on Monday. Conservative Republicans have said the law does not go far enough, moderate Republicans are worried about its changes to Medicaid expansion, conservative groups have called it "Obamacare Lite," and Democrats have said it will rip insurance away from Americans.

Even the AARP criticized a tweak in the law about how much an insurer can charge older patients compared to younger ones.

President Trump defended the law during a meeting around the same time as the Republican press conference bashing it.

"We're going to do something that’s great. And I am proud to support the replacement plan released by the House of Representatives," Trump said. "It follows the guidelines I laid out in my congressional address. … This will be a plan where you can choose your doctor and this will be a plan where you can choose your plan. And you know what the plan is. This is the plan."

Members of the House GOP leadership came out after meeting with Trump and said that the executive branch is supporting the AHCA.

"This president made it very clear to us that he wants us to pass this legislation," said Rep. Patrick McHenry, the Republican chief deputy whip.

Watch Trump's comments below:

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House Speaker Paul Ryan on Tuesday defended the House GOP leadership's plan to repeal and replace the Affordable Care Act, calling the overhaul of the healthcare system an "act of mercy" and guaranteeing it would have enough votes to pass the House.

Ryan said the legislation, called the American Health Care Act (AHCA), fulfilled Republican promises to repeal and replace Obamacare and would help to unburden average Americans from high healthcare costs.

"If we did nothing the law would collapse, and leave everybody without affordable healthcare," Ryan said at a press conference with other House GOP leaders. "We are doing an act of mercy by repealing this law and replacing it with patient-centered healthcare reforms."

Ryan also said that the ACA was "collapsing" on its own, despite relatively stable enrollment numbers in the individual insurance exchanges over the past few years.

The speaker claimed the bill was being progressed transparently, as opposed to the ACA, which he said was "jammed through to an unsuspecting country." The new plan, however, has not yet received a score from the Congressional Budget Office to assess its budgetary or coverage effects.

Ryan said he plans to have the bill for a floor vote in two weeks. By comparison, Timothy Jost — a professor of health policy at Washington University in St. Louis who favors the Affordable Care Act — documented that the House had 79 hearings on the ACA over a year, heard from 181 witnesses during that time span, and added 121 amendments to the law.

The press conference occurred shortly after members of the influential House Freedom Caucus and conservative senators held an event attacking the AHCA for not going far enough in its repeal. Despite the pushback, Ryan said that he would have the 218 votes needed pass the bill.

"When this thing comes to the floor, we'll have 218," said Ryan. "I can guarantee you that."

SEE ALSO: The Trump administration just made promises about the Obamacare replacement that will be hard to keep

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WASHINGTON (AP) — After more than 60 votes and seven years of promises, Republicans offered their long-awaited plan to repeal and replace the Affordable Care Act.

Now, the real work begins. Republicans must navigate a complicated path to turn their 123-page proposal from legislation to law.

A look at the process and the politics:

___

What happens next?

Republicans have set an aggressive timetable for moving the bill.

Two House committees — Ways and Means and Energy and Commerce — plan to take up the legislation on Wednesday. Republican leaders hope the committees will approve the measure this week, allowing the full House to pass the bill before lawmakers leave for the spring recess in early April.

The legislation will then move to the Senate, where a tighter Republican majority makes the outlook even more uncertain.

Normally, legislation requires 60 votes to pass the Senate. But because Republicans hold just 52 seats, they plan to use a budget maneuver known as reconciliation to pass the bill on a simple majority.

Even that may be difficult. Senate rules require that any bill passed by reconciliation cannot increase the deficit over the long term.

Republicans said on Tuesday that they'd not received official estimates on the costs of bill from the Congressional Budget Office.

Senate Majority Leader Mitch McConnell, R-Ky., said on Tuesday he wants to pass the bill before the April recess, sending it to President Donald Trump for his signature. President Barack Obama signed the health care bill 14 months after entering office.

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A tight margin?

How the congressional process unfolds will depend on how Republicans maneuver through some complicated intra-party politics.

Conservative Republicans are worried about the cost of the overhaul, fearing the GOP would essentially be replacing one mandatory federal program with another.

Sens. Rand Paul of Kentucky, Mike Lee of Utah and Ted Cruz of Texas, dubbed an early draft "Obamacare Lite." On Tuesday, influential conservative groups — Heritage Action, FreedomWorks, the Club for Growth, Americans for Prosperity, and Freedom Partners — came out against the proposal.

Moderate lawmakers, meanwhile, fear their constituents could lose access to health care.

On Monday, Republican senators from Ohio, West Virginia, Colorado and Alaska signed a letter saying the House bill didn't sufficiently protect "the country's most vulnerable and sickest" in 31 states that accepted federal dollars to expand Medicaid coverage under the law.

Provisions to reverse taxes on the wealthy and deny federal funding for one year to Planned Parenthood, a major provider of women's health services, could also open swing state lawmakers to criticism.

Democrats, under pressure from their base to resist every part of Trump's agenda, are expected to lend little help.

With no Democratic support, Republicans can't lose more than two votes in the Senate and 21 in the House.

That's a margin that makes even some top Republicans admit their party has little wiggle room.

"I am going to be very anxious to hear how we get to 51 votes and how the House gets to 218," Missouri Sen. Roy Blunt, vice chairman of the Senate GOP, told reporters on Tuesday.

SEE ALSO: Republican governors are complaining about the GOP healthcare plan

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Up to 10 million Americans could lose their health insurance under the American Health Care Act (AHCA), the House GOP leadership's plan to repeal and replace the Affordable Care Act (aka Obamacare), according to a report published on Tuesday.

In the report, S&P Global Ratings, a research arm of the credit-rating agency S&P, broke down the bill and its effect on the number of uninsured Americans, providing some clarity on one of the big questions about the legislation.

"We expect a decline in enrollment in the individual (2 million to 4 million) and Medicaid (4 million to 6 million) segments, resulting in a decline in premiums," the S&P report read.

Together, based on the S&P estimates, the number of people without insurance could rise by 6 million to 10 million people.

Individual market

The S&P broke down the AHCA's effects on the two major markets, first focusing on the individual market for people who do not get their insurance through their employer or a government program like Medicaid or Medicare. These are the people who most likely access care through Obamacare exchanges, which have been repeatedly lampooned by Republicans.

According to the S&P, the shift from tax credits based on income and residence under the ACA to the AHCA's block tax credit based on age would cause a number of older and poorer beneficiaries to remove themselves, since their assistance compared to their higher premiums would likely drop.

This is also partly because, as the S&P found, the "age band" from the ACA is loosened in the AHCA.

"Under the current ACA rules, an insurer is allowed to charge three times as much for a 64-year-old as for a 21-year-old. The replacement plan widens this rate band," the report said. "The wider rate bands (5:1) will reduce premiums for the eligible younger population, while likely increasing premiums for the older population."

Using the average premium costs for a 21-year-old and adjusting for the new band — and doing the same for a 64-year-old — the S&P estimated just how much the AHCA would affect older patients.

"The proposed tax credits of $2,000 in the replacement plan, although not covering the entire premium cost for a 21-year-old, would reduce it by almost 75%," the report said. "The proposed $4,000 tax credit for a 64-year-old falls well short of the potential premium cost, reducing premiums by only 30%."

The analysts expect the number of people with insurance through the individual market to drop by up to 4 million.

Medicaid expansion

The AHCA would also change the way the government funds the ACA's expansion of Medicaid. The program provides low-income earners with insurance through the government. Under Obamacare, this was extended to anyone making 138% above the federal poverty line.

The funding for the expansion came through the federal government.

Here's the breakdown on how this would change under the AHCA, from the S&P report (emphasis added):

"The proposal also changes the financing of the expansion population. It allows new enrollees to join the expansion ranks until Dec. 31, 2019. But, after 2019 it doesn't provide federal funding for any new eligible enrollees that aren't already on the roles or for any current enrollee that has more than a month's break in eligibility. This effectively puts Medicaid expansion in "run-off" after 2019. The Medicaid program enrollees generally have a lot of churn due to change in income levels. Starting 2020, even a low level of churn among the "run-off" expansion enrollees will result in a gradual decline in enrollment."

After 2019, the number of people on the Medicaid rolls would dwindle, the report concluded, as states face a funding gap and people move off of Medicaid for various reasons.

Some Republicans have said the new plan would cover fewer people. Most GOP lawmakers have focused on "access" to coverage — rather than a guarantee that the same number of people would be covered.

This may run into some issues in the Oval Office, though, since President Trump, a supporter of the new law, has said that he wants a healthcare plan that covers "everybody."

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House Republicans on Monday released legislation that would repeal and replace the Affordable Care Act, better known as Obamacare.

And after much analysis by politicians and the media on Tuesday, it looks like the new plan isn't going over any more smoothly than Obamacare did. Some conservatives have said the new plan is "Obamacare lite."

Stephen Colbert examined it all in his opening of Tuesday's "Late Show."

First, he pointed to things in the existing plan that would stay under "Trumpcare": People could stay on their parents' healthcare plan until they are 26, and insurance companies couldn't discriminate because of preexisting conditions.

But then Colbert got into the new elements, such as insurance company executives who make over $500,000 receiving a tax break — "So all of them?" Colbert said — and the fact that Republicans released the bill without cost estimates from the Congressional Budget Office.

"So this bill is going to be like those fancy restaurants where they don't have what it costs on the menu," Colbert said.

He also said that experts had estimated the Republican healthcare plan would cover "20 million fewer Americans than Obamacare."

In short, Colbert said he thought the only person who liked this plan was the Grim Reaper, who came onstage and danced with Colbert.

"We're all gonna die," Colbert said jokingly as the Grim Reaper walked off the stage.

Then Colbert addressed press secretary Sean Spicer's visual prop at his press briefing on Tuesday, in which he stacked the new 123-page healthcare bill next to Obamacare's 974 pages, that was meant to show how much better the new bill was.

"When it comes to writing anything down, shorter is always better," Colbert said. "Look, if shorter is better, why not just a one-page plan that says 'Walk it off'?"

Watch Colbert's complete opening:

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Republicans have unveiled their package to overhaul the Affordable Care Act, and at least one CEO of a health insurer is wary that the plan could lead to massive premium hikes.

In an interview with The Wall Street Journal, Mario Molina, the CEO of Molina Healthcare, predicted that the new AHCA would cause an increase in the cost of premiums for people in the individual insurance market.

Molina's firm provides a large offering of managed Medicaid plans for the government and is also active on the individual health-insurance exchanges set up by the ACA in nine different states.

In the interview with The Journal, Molina said premiums for the more than 12 million people in the individual insurance market could skyrocket by more than 30% next year. In 2017, the benchmark silver plan in the same market increased by 25%, which was decried by many GOP lawmakers, including President Donald Trump.

"You're going to see big rate increases, and you're going to see insurers exit markets … this is going to destabilize the marketplace,"Molina told The Journal.

Molina Healthcare was also one of the most successful insurance companies on the Obamacare exchanges. Using its stripped-down plans modeled on Medicaid offerings, unlike other large insurers that modeled their plans on more expensive employer coverage, the company turned a profit on the exchanges over the past few years.

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Reactions have streamed in since House Republicans on Monday introduced their bill designed to replace Obamacare.

Titled the American Health Care Act, the bill aims to repeal and replace the Affordable Care Act, overhauling the healthcare system.

The bill tries to preserve some of the well-regarded aspects of the ACA, such as allowing people with preexisting conditions to keep their coverage — so long as they don't have a lapse in insurance.

At the same time, some estimates say millions of Americans could lose their insurance under the AHCA. And the AHCA is already facing backlash from conservative Republicans who have nicknamed the bill "Obamacare 2.0."

Doctors' organizations, hospital groups, and patient advocacy groups also do not seem to be the biggest fans of the bill in its current form. Here's what some of the major groups have said.

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American Medical Association — "We cannot support the AHCA as drafted."

The biggest group of doctors in the US called the bill "critically flawed."

"While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations," the AMA said in a letter to Congress. The organization said it wouldn't support the bill's plans to roll back Medicaid expansion or the repeal of the Prevention and Public Health Fund, which helps fund the Centers for Disease Control and Prevention. 

The AMA had concerns about the tax-credits structure proposed in the bill. "We believe credits inversely related to income, rather than age as proposed in the committee's legislation, not only result in greater numbers of people insured but are a more efficient use of tax-payer resources."

Here's the full letter.

American Academy of Family Physicians — "We strongly disagree with statements that suggest the AHCA will provide every American 'access to health care coverage.'"

The national association of family doctors also had concerns about the number of people who could be negatively affected by the bill.

"We strongly disagree with statements that suggest the AHCA will provide every American 'access to health care coverage.' 'Access to health care coverage' is distinctly different than 'securing health care coverage,'" the organization's board chair, Dr. Wanda Flier, said in a letter.

The AAFP's concerns also focused on making sure that the relationship between patients and physicians wasn't interfered with. 

Here's the full letter.

American College of Physicians — "We urge you to oppose the American Health Care Act."

The organization, which represents 148,000 internal-medicine physicians and medical students, echoed some of the AMA's concerns about tax credits and Medicaid rollback.

The ACP also worried that those with preexisting conditions, while still technically covered, may not be able to afford coverage under the AHCA.

"We urge you to oppose the American Health Care Act because it would weaken key gains in coverage and consumer protections and lead to fewer people having access to affordable coverage," Dr. Nitin Damle, the ACP president, wrote in a letter to Congress.

Here's the letter.