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- 03/08/17--11:29: _The GOP Obamacare r...
- 03/08/17--12:31: _Only the rich get w...
- 03/08/17--13:09: _This is what happen...
- 03/08/17--14:53: _Republicans will re...
- 03/08/17--15:18: _The White House doe...
- 03/08/17--15:25: _Mark Cuban fires hi...
- 03/08/17--16:02: _POLL: Majority of A...
- 03/09/17--02:07: _A predawn vote just...
- 03/09/17--04:27: _Democrats are tryin...
- 03/09/17--05:32: _TOP REPUBLICAN SENA...
- 03/09/17--06:15: _Some huge insurers ...
- 03/09/17--07:04: _CNN anchor dismisse...
- 03/09/17--07:41: _Medicaid's top doct...
- 03/09/17--07:52: _PAUL RYAN: I don't ...
- 03/09/17--09:10: _Paul Ryan just gave...
- 03/09/17--09:29: _TRUMP: The Obamacar...
- 03/09/17--11:24: _The GOP's Obamacare...
- 03/09/17--11:36: _Trump tells conserv...
- 03/09/17--12:07: _People on Twitter a...
- 03/09/17--13:57: _Here's how the GOP'...
- 03/08/17--12:31: Only the rich get what they want out of this Obamacare-repeal bill
- 03/08/17--13:09: This is what happens to your brain when you take Xanax
- 03/08/17--14:53: Republicans will regret ignoring the Congressional Budget Office
- 03/08/17--15:25: Mark Cuban fires his opening salvo at attempting to fix Obamacare
- Change the short title of the AHCA to the "Republican Pay More for Less Care Act."
- The bill cannot pass unless the Congressional Budget Office and Joint Committee on Taxation say it will lower out-of-pocket costs for Americans, lower premiums, and provide more people coverage. These were three promises made by President Donald Trump in the lead-up to the bill's introduction. This was defeated by a party-line vote of 31 to 23 overnight.
- The bill cannot pass until "the individual who holds the office of President makes available to the public authenticated copies of the individual's returns of Federal income tax for the most recent ten taxable years." In other words, the amendment would require Trump to release his tax returns if the bill is passed.
- The bill cannot leave committee until the CBO has scored the bill and the score has been public for 30 days. Numerous other amendments were attached to CBO scores, including that the CBO must certify that more people will have insurance under the AHCA and that there will be no reduction in mental-health services. A score from the CBO is not expected until next week.
- Strike the "per capita cap-based payments under Medicaid" in the AHCA and stay with the current Medicaid expansion funding. This amendment was also defeated by a 31-to-23 vote.
- Preserve federal funding for Planned Parenthood, which the AHCA would do away with. This was defeated on a 31-to-23 vote along party lines.
The tax-credit structure: Obamacare, formally known as the Affordable Care Act, bases the amount of tax relief a person receives on the person's income and place of residency. The AHCP would instead give Americans a set amount based on their age.
The letter, which was from AHIP CEO Marilyn Tavenner to House GOP leaders Kevin Brady and Greg Walden, said: "Tax credits related to age as well as income will help ensure that more people stay covered, and are the most efficient and effective way to allocate tax-payer dollars."
- Changes to Medicaid expansion funding: The Letter from the AHIP said the changes to the Medicaid expansion, which allowed more than 11 million people in 34 states and the District of Columbia to gain health insurance, could "result in unnecessary disruptions in the coverage and care" for those on Medicaid. The letter also says that Medicaid is at the "forefront of providing coverage for and access to behavioral health services and treatment for opioid use disorders" and that a shift in funding could put those people even more at risk.
- 03/09/17--13:57: Here's how the GOP's Obamacare replacement bill could become law
A huge test awaits the American Health Care Act — the House GOP leadership's Obamacare replacement— and early indications point toward a failing grade.
The Congressional Budget Office, the nonpartisan legislative office, has yet to score the AHCA, which was released Monday, and the political fate of the bill could depend on the CBO's decision.
The CBO score is the legislative equivalent of an environmental-impact report required before a skyscraper is built. The CBO score looks at the broad effects of the bill on a variety of factors, measuring its benefits against its costs.
For the AHCA, the CBO will assess not only the effects on the government's finances, but also the implications for Americans' insurance coverage.
The White House, Democrats, and even House Republicans have said the CBO score should be taken into account as Congress shapes the legislation.
"That's the work that somebody mentioned over here — the Congressional Budget Office score — and once the Congress receives that score, then they'll be working through that to make certain that in fact it is fiscally responsible," Secretary of Health and Human Services Tom Price said Tuesday.
There is a problem for the House GOP, however: Most analysts assume the score will be ugly — possibly really ugly.
Chris Jacobs, a Republican health-policy adviser who worked under current Vice President Mike Pence during the original debate over Obamacare, reported in The Federalist on Monday that Republican staffers were expecting a rough score from the CBO.
Jacobs said that sources told him the CBO could estimate that 10 million to 20 million people who have employer-based insurance could lose coverage, as companies could decide to allow people to use the tax credits under the AHCA to buy their own insurance instead of offering insurance through work.
Additionally, Jacobs said, the CBO score could indicate that repealing the taxes associated with Obamacare while maintaining tax credits would lead to a sizable increase in the federal deficit.
While tweaks were made to the AHCA between his reporting, which was based on a draft version, and the release of the final bill, most of the plan Jacobs described is intact.
Other health-policy analysts have suggested the CBO score could put the GOP in a politically perilous situation.
"If Democrats drag out the markup until next week, the CBO score will land smack dab in the middle of the markup. That will be...devastating," Topher Spiro, the head of healthcare policy for the Center for American Progress, a liberal-leaning think tank, said in a tweet.
Avik Roy, a longtime critic of Obamacare and former health-policy adviser to multiple Republican presidential candidates, wrote in Forbes that the CBO score would likely show massive insurance losses.
"The CBO is likely to score the AHCA as covering around 20 million fewer Americans than Obamacare," Roy wrote. "There are flaws in the way the CBO models health reform legislation, but the AHCA itself contains enough flaws that there can be little doubt that the plan will price millions out of the health insurance market."
In light of this, Republicans seem to be preemptively undercutting the agency.
Sen. Tim Scott told Talking Points Memo in an interview that "the CBO is consistently inconsistent," and Rep. David Brat said the CBO has "scored everything wrong for decades." White House press secretary Sean Spicer also took a jab at the agency on Wednesday.
"If you're looking at the CBO for accuracy, you're looking in the wrong place," Spicer said during the White House press briefing.
The bill is being debated and marked up by the House Energy and Commerce Committee and Ways and Means Committee before it goes to the full House for a vote.
Because of the last-minute changes, however, House Speaker Paul Ryan said in a press conference on Wednesday that he did not expect the CBO score until sometime "early next week." Staffers for House Minority Leader Nancy Pelosi said they expected the score on March 16.
Ryan has said he wants to get the AHCA to a full floor vote within two weeks.
If you watched any television in 2010, you might recall that the Affordable Care Act cut $500 billion from Medicare over a decade.
You probably learned that because House Republicans' campaign committee blanketed the country with ads attacking Democrats for cutting $500 billion from Medicare.
"Let's save Medicare," the National Republican Congressional Committee said in one typical ad urging the election of a Republican majority.
Seven years later, Republicans are fully in charge in Washington, and a "repeal" plan being considered by the House of Representatives this week would undo large parts of Obamacare.
But it would leave the Medicare cuts in place. Womp womp.
Republicans can't help break lots of promises
People oppose Obamacare for a variety of reasons, and Republicans capitalized on all those reasons in their campaign against the law. In doing so, they made more promises than they could deliver on.
Republicans would say in one breath that Obamacare cost the government too much money and that premiums were too high, in part because its regulations required insurance to pay for too much. In another breath, they would say that deductibles and copayments under Obamacare insurance plans were too high — even though reducing those deductibles and copayments would require premiums to go up.
Obamacare was financed by raising taxes and cutting Medicare. So Republicans decried the tax increases, and they decried the Medicare cuts even more loudly.
But because Republicans (mostly) acknowledge the need to maintain some sort of health-insurance subsidy as a replacement for Obamacare, which will cost money, they won't be able to undo all the tax increases and all the Medicare cuts without exploding the deficit. Yet Republicans are also opposed to deficits.
Now that Republicans run the government, we are seeing which set of concerns they choose to prioritize, given limited available resources.
The unsurprising answer is that Republicans will make a priority of repealing substantially all the tax increases in Obamacare, most of which fall on people who make over $200,000 a year. If House Speaker Paul Ryan gets his way, people who hated Obamacare because of the taxes it imposed will get nearly everything they wanted.
But much of the rest of the law would stay in place. And people who hated the law for non-tax reasons — they thought insurance premiums were too high, they didn't like being penalized for not having insurance, they didn't like cuts to Medicare — mostly wouldn't get what they were expecting.
Cuts for Medicare participants are here to stay
The House Republicans' plan would retain Obamacare's cuts to Medicare, including reductions to rates providers are paid for caring for Medicare patients and the elimination of bonus benefits once enjoyed by participants in private Medicare Advantage plans.
You might assume that's because the plan is not a full Obamacare repeal — as Sen. Rand Paul complains, it's "Obamacare lite."
Yet the "full" repeal plan touted by conservatives, which passed Congress in 2015 and was vetoed by President Obama, and which Paul said he would reintroduce in this Congress, also kept in place the cuts to Medicare benefits.
Lots of other Obamacare complaints are also unaddressed by the House plan
A lot of people don't like the individual mandate in Obamacare. The House plan would repeal the existing mandate but replace it with another one payable directly to insurance companies — a 30% penalty premium if you let your health insurance lapse.
Other people were upset about Obamacare because their healthcare costs went up — perhaps for reasons related to Obamacare, perhaps for other reasons. Yet this plan has no apparent architecture for cost control. Republicans' major cost-control idea, a cap on the tax benefit for health insurance, might have helped discourage spending growth in the long run but was scrapped in negotiations over the plan.
Of course, what consumers really care about is healthcare costs borne by them, not global costs. The Republicans' plan offers more generous healthcare subsidies to some consumers. But it also cuts the subsidies enjoyed by many, especially people who live in rural areas with high healthcare costs, and people between 50 and 64 — both disproportionately Republican groups.
The few people who like this plan care mostly about tax cuts
Because the House plan addresses so few of the objections to Obamacare, and because it would at the same time cut benefits created by Obamacare that many people rely on, the rollout of the plan has gone poorly.
Moderate Republican senators are wary of big cuts to Medicaid, while conservative groups like Heritage Action for America and FreedomWorks say the plan leaves too much of Obamacare's benefits infrastructure in place. Defectors from the far right and from the center threaten passage of the plan.
But a few players have praised the plan: The Wall Street Journal editorial board, the Chamber of Commerce, and the antitax advocate Grover Norquist, to name a few.
What these people praising it have in common is that they are mostly interested in healthcare policy because healthcare spending is paid for with taxes, and the plan would cut taxes, including by reducing capital-gains taxes on high earners by 3.8 percentage points.
The biggest new tax under Obamacare is on people making over $200,000, but there are also taxes on health-insurance premiums, medical devices, branded pharmaceuticals, tanning services, and more. If you operate a tanning salon, this plan has what you wanted out of Obamacare's "repeal."
It matters which half of the loaf you get
You will see Republican leaders argue that various factors constrain what Republicans can deliver on healthcare — for example, the popularity of the requirement that insurers cover people with preexisting conditions, and the limitations on what can pass the Senate with a simple majority.
Take this plan, they will say, because it's better than the status quo and we can do more later.
But the question is, better for whom?
This Obamacare-repeal plan leaves out much of the wish list of the anti-Obamacare coalition. It lacks most of the deregulatory provisions that were supposed to make insurance cheaper and offset the reductions in subsidies offered to many Americans. It would likely result in millions of Americans losing health insurance. It offers no restoration of Medicare benefits to the seniors who were activated to vote Republican over Medicare cuts in the 2010 election.
Yet curiously, some groups did not have to compromise: wealthy people, medical-device manufacturers, pharmaceutical companies, tanning salons.
Funny how that works, even in President Trump's newly populist Republican Party.
Update: An earlier version of this article said the House Republicans' replacement plan would keep only about 95% of Medicare cuts from the Affordable Care Act and would undo some cuts to Medicare payments made to hospitals to compensate them for providing care to uninsured people. This is incorrect; the replacement plan would undo cuts to such hospital payments under Medicaid, not the payments under Medicare.
Dr. Samoon Ahmad is a practicing psychopharmacologist and psychiatrist. He explains what happens to someone's brain when they take Xanax. He also discusses some of the long-term side effects of using Xanax. Following is a transcript of the video.
It works on a receptor, which is called the GABA receptor. GABA usually keeps a sense of calmness. It has sedative
properties. It has muscle relaxant properties. You feel a good feeling in that way.
One may feel the effects for approximately I would say three to four hours. And then one may need to repeat it at that time to get the effect again. And it lasts in your system approximately eight hours or so. So it washes out pretty quickly. Benzodiazepines, including Xanax, can cause cognitive problems. Over a period of months to years people can have memory problems.
You become psychologically and physically addicted to the medication. If you don't take it you can develop severe withdrawal. You'll become restless, you will become irritable, you will become edgy, you won't be able to sleep. You may start to have gastric problems, you may feel sweaty. You start to lose all of the positive effects of the medication. And because it has a short half-life, you need to increase it and you need to take it more frequently.
Rather unusually, Republicans in the House of Representatives are intent on moving their plan to repeal and replace Obamacare through committees before they even have estimates of how much the plan will cost, how many people it will cover, or what it will do to insurance premiums.
The Congressional Budget Office will likely come out with those estimates next week. If Republicans succeed in rushing the "markups" of the Obamacare bills, they will already have been voted out of committee and sent to the House floor by then.
Why the rush? Republicans are afraid the CBO report is going to say the plan will cause a ton of people to lose health insurance, so they're preparing to disregard it.
"If you're looking to the CBO for accuracy, you're looking in the wrong place," White House press secretary Sean Spicer said at Wednesday's press briefing.
Republicans are within their power to disregard the CBO's report if they wish.
But there are a couple of reasons they'll probably regret it if they do.
The first is accuracy: Like any forecast, the CBO's forecast almost certainly won't predict the future exactly. But the CBO did better than most other forecasters at estimating the effects of the Affordable Care Act on coverage and prices.
The CBO has deep expertise and isn't biased in the way forecasters with a stake in the outcome of the legislative fight often are. Now, the CBO even has a Republican director who was appointed by Republicans, which would seem to undermine claims of anti-Republican bias.
The CBO's model will almost surely more accurate than President Donald Trump's, which seems to consist entirely of guessing.
But even if the CBO is way wrong, that won't save Republicans from trouble for ignoring it.
People are always upset about healthcare. Healthcare costs rise every year, usually faster than the overall rate of inflation. When that happens, people tend to blame whoever last made a big change to health care policy. If this law passes, that will be Trump, originator of Trumpcare.
Of course, to the extent the plan causes millions to lose health insurance, that means even more people who will be very angry and looking for someone to blame.
When that dissatisfaction arises, Republicans won't be able to say they weren't warned — because even if CBO's forecasts fail to accurately describe the terms of the misery, the misery will still be there.
President Donald Trump's administration, its media boosters, and its critics are playing a game of nickname hot potato with the Republican bill to repeal and replace Obamacare.
Much like Republicans shifted the conversation to dub Democrats' healthcare overhaul "Obamacare," opponents of the American Health Care Act are trying to pin the bill on a single politician.
The only difference with the AHCA is that there are now two alternatives being thrown out: "Trumpcare" and "Ryancare."
Trumpcare seems to be the tag of choice for many Democrats. Senate Minority Leader Chuck Schumer called the bill "Trumpcare" on the Senate floor Tuesday.
The Trump team, however, has pushed back on the name. White House spokesperson Kellyanne Conway pushed for the use of the official name instead of "Trumpcare" during an interview with Fox News on Wednesday.
"I'll call it Trumpcare if you want to, but I didn't hear President Trump say to any of us, 'Hey, I want my name on that,'" Conway said. "We're happy it is the American Health Care Act. This is serious stuff. This isn't branding according to someone's name."
Secretary of Health and Human Services Tom Price also deferred when asked whether he would call the bill "Trumpcare" at a White House press briefing on Tuesday, saying he would "let others provide a description for it" and that he liked "Patientcare" better.
After his administration discouraged it through much of his first term, President Barack Obama embraced the name Obamacare as far back as 2011, saying it showed he cared about Americans. (Polls have shown Americans dislike the ACA much more when it is called "Obamacare" rather than the "Affordable Care Act," however.)
The American Health Care Act's other emerging nickname, "Ryancare"— a nod to House Speaker Paul Ryan — has popped up in a diverse group of places.
Right-leaning websites, including Breitbart, have pinned the "Ryancare" label on the AHCA because of reasons stemming from discontent — they do not think the bill goes far enough in repealing Obamacare.
At the same time, left-leaning websites like the Daily Kos and Daily Beast have used the "Ryancare" moniker to attack the law for going too far and possibly leading to the loss of health coverage for millions of Americans.
The conservative group Club for Growth similarly used the moniker in its rebuke of the healthcare bill.
As the bill progresses through the House and Senate, it remains to be seen which of the names — if any — will stick.
Billionaire businessman Mark Cuban pitched his own plan to fix the Affordable Care Act on Wednesday, amid the House Republican effort to unravel the law.
He detailed the idea on his blog, Blog Maverick. It amounted to single payer coverage for chronic physical and mental illnesses and life-threatening injuries, and standard insurance for all other healthcare.
The owner of the Dallas Mavericks and star of ABC's "Shark Tank" encouraged readers to "shoot holes" in the plan.
"Whether it's Medicaid or a new program, every single person in this country should be covered 100% for chronic physical or mental illness and for any life-threatening injury.
"The premiums that we are paying to insurance companies as individuals or as company coverage for these significant risks would go from the insurance companies to the IRS. Only the cost of covering the what’s left would continue being paid to the insurance companies.
"It would not be hard to do the math. Every insurance company does this analysis already. The government does this analysis already. We all would end up paying more in taxes, but less in insurance and healthcare costs over time.
"There would be no mandates. There would be no individual penalties. No tax credits. No subsidies. No offsets or deductions for buying higher end insurance. This will be single payer (yes I know it's a dirty phrase in this country) for chronic physical or mental illness and for any life threatening injury.
"Everything not covered by the above can be covered by insurance sold on the free market, managed by the states, sold across state lines, without government interference."
House Republicans released their proposal to replace the Affordable Care Act, otherwise known as Obamacare, earlier this week. But while the proposal has been endorsed by President Donald Trump and his administration, many in the more conservative wing of the GOP have slammed the proposal, such as Sen. Rand Paul of Kentucky and Rep. Justin Amash of Michigan, who believe it amounts to "Obamacare Lite" or "Obamacare 2.0."
Cuban has flirted with the idea of a presidential bid in the past, recently telling Business Insider "we will see" when asked if he was considering a run at the White House. A recent poll showed that, if he was the Democratic nominee running against Trump (Cuban is not currently registered with a political party), the billionaire businessman would be in a neck-and-neck race with the sitting president.
A slight majority of American voters are opposed to President Trump's and Congress' efforts to repeal the Affordable Care Act, according to a new Quinnipiac University poll released Wednesday.
51% of voters do not think Trump should support efforts to repeal Obamacare, while 49% believe that Trump should work with Congress to repeal parts of the former president's signature healthcare law.
Meanwhile, 21% believe Obamacare should be repealed in its entirety, and 27% believe there should be no repeal at all.
The issue of healthcare has taken center stage over the last few days, as Congressional Republicans introduced the first in a slew of changes they plan to bring to the healthcare system.
Republican leadership, spearheaded by House Speaker Paul Ryan, House majority leader Kevin McCarthy, and Vice President Mike Pence, introduced their plan to repeal and replace Obamacare on Monday. The proposed plan would do away with the individual mandate and effectively defund Planned Parenthood, as well as 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.
While the proposal was received well by Trump, who tweeted that the "wonderful" bill was up for review and negotiation, many conservatives balked at it and said it did not go far enough to repeal Obamacare.
Americans also feel strongly about the US' policy towards Russia and Attorney General Jeff Sessions' handling of the recent controversy surrounding the Trump campaign.
51% of voters believe Sessions should resign, in light of reports that indicate contacts between Sessions and Russian officials during the 2016 presidential election – during which he was a frequent surrogate for then-candidate Trump.
Sessions recused himself from any further Justice Department investigations into the Trump campaign after the FBI opened an inquiry into his conduct during the campaign.
"The gavel comes down hard on Attorney General Jeff Sessions," said Tim Malloy, assistant director of the Quinnipiac University Poll. "He lied and he should quit because of it, say Americans, who are clearly very concerned about the Russian affair and all the administration personnel involved with it."
Voters disapprove of Trump's policy towards Russia and 61% are at least "somewhat concerned" with the president's relationship with Russia and Vladimir Putin. 62% believe that Russia's interference in the 2016 election is either "very important" or "somewhat important."
They also overwhelmingly support establishing an "independent commission" to investigate ties between Trump advisers and the Kremlin, by a margin of 66% in favor to 30% opposed. Among Republican voters, 64% oppose an independent commission, while 30% favor it.
On immigration, 63% of voters – the highest number since Quinnipiac first started asking this question in 2012 – believe illegal immigrants should be allowed to remain in the country and support a path to citizenship. 11% believe undocumented immigrants should be allowed to stay but do not support a path to citizenship, and 23% believe they should be deported.
WASHINGTON — Republicans on a pivotal House committee scored an initial triumph in their effort to scuttle former President Barack Obama's healthcare overhaul, using a predawn vote Thursday to abolish the tax penalty his statute imposes on people who don't purchase insurance and reshaping how millions of Americans buy medical care.
Yet the panel's approval of healthcare legislation only masked deeper problems Republican backers face. Hospitals, doctors, and consumer groups mounted intensifying opposition to the GOP healthcare drive, and the White House and Republican leaders labored to rally a divided party behind their high-stakes overhaul crusade.
The American Medical Association, the American Hospital Association, and AARP, the nation's largest advocacy group for older people, were arrayed against the measure. Seven years ago their backing was instrumental in enacting Obama's healthcare statute, which President Donald Trump and Republicans are intent on erasing.
The hospitals — major employers in many districts — wrote lawmakers complaining about the bill's cuts in Medicaid and other programs and said more uninsured Americans seem likely, adding, "We ask Congress to protect our patients." Groups representing public, children's, Catholic, and other hospitals also expressed opposition.
America's Health Insurance Plans, representing insurers, praised the legislation's elimination of health-industry taxes but warned that proposed Medicaid changes "could result in unnecessary disruptions in the coverage and care beneficiaries depend on."
In epic sessions that began Wednesday morning, Ways and Means worked until nearly 4:30 a.m. ET before approving the final batch of tax provisions in a 23-to-16 vote along party lines. The Energy and Commerce Committee panel continued working, tackling a reshaping of Medicaid.
GOP leaders faced rebellion within their own ranks, including from conservative lawmakers and outside conservative groups claiming the bill took too timid a whack at Obama's law. Numerous GOP centrists and governors were also antagonistic, worried their states could lose Medicaid payments and face higher costs for hospitals having to treat growing numbers of uninsured people.
Top Republicans knew if the upheaval should snowball and crush the legislation, it would be a shattering defeat for Trump and the GOP, so leaders hoped approval by both House committees would fuel momentum.
In words aimed at recalcitrant colleagues, House Speaker Paul Ryan told reporters: "This is what good, conservative healthcare reform looks like. It is bold and it is long overdue, and it is us fulfilling our promises." The last was a nod to campaign pledges by Trump and many GOP congressional candidates.
Outnumbered Democrats used the panels' meetings for political messaging, futilely offering amendments aimed at preventing the bill from raising deficits, kicking people off coverage, or boosting consumers' out-of-pocket costs. They tried unsuccessfully to insert language pressuring Trump to release his income tax returns and failed to prevent Republicans from restoring insurance companies' tax deductions for executive salaries above $500,000 — a break Obama's law killed.
There were signs of growing White House engagement and, perhaps, of progress.
Trump met at the White House late Wednesday with leaders of six conservative groups that have opposed the GOP legislation, and several voiced optimism afterward.
"I'm encouraged that the president indicated they're pushing to make changes in the bill," said David McIntosh, the head of the Club for Growth, though he provided no specifics.
Underscoring Trump's potential impact, the Energy and Commerce chairman, Greg Walden, an Oregon Republican, said of GOP holdouts, "A lot of them, they maybe haven't felt the inertia that comes with Air Force One landing in their district."
The legislation would defang Obama's requirement that everyone buy insurance — a provision deeply disliked by Republicans — by repealing the tax fines imposed on those who don't. That penalty has been a stick aimed at pressing healthy people to purchase policies. The bill would replace income-based subsidies Obama provided with tax credits based more on age, and insurers would charge higher premiums for customers who drop coverage for over two months.
The extra billions Washington has sent states to expand the federal-state Medicaid program would begin ending in 2020, and spending on the entire program would be capped at per-patient limits. About $600 billion in 10-year tax boosts that Obama's statute imposed on wealthy Americans and others to finance his overhaul would be repealed. Insurers could charge older customers five times as much as younger ones instead of the current 3-to-1 limit but would still be required to include children up to age 26 in family policies, and they would be barred from imposing annual or lifetime benefit caps.
"We will answer President Trump's call to action," said the Ways and Means chairman, Kevin Brady, a Texas Republican, adding later, "Relief is on the way."
Democrats said the Republicans would yank health coverage from many of the 20 million Americans who gained it under Obama's statute and drive up costs for others because the GOP tax breaks would be skimpier than existing subsidies. And they accused Republicans of hiding bad news by moving ahead without official estimates from the nonpartisan Congressional Budget Office on the bill's cost to taxpayers and anticipated coverage.
"You can expect more town-hall meetings you won't want to go to," said Rep. Sander Levin, a Michigan Democrat, a reference to liberal activists who hounded Republicans during last month's recess.
AP Congressional Correspondent Erica Werner and reporters Andrew Taylor, Kevin Freking, Mary Clare Jalonick and Ken Thomas contributed to this report.
Democrats have begun their fight against the GOP's replacement for the Affordable Care Act, the healthcare law better known as Obamacare.
As the House Energy and Commerce Committee on Wednesday held its first day of debate over the GOP replacement, the American Health Care Care Act, Democrats introduced a series of largely symbolic amendments to add to the bill. While the amendments will be considered by the committee, they have to be approved by a majority vote in the Republican-controlled committee to officially become part of the bill.
Here's a quick rundown of some of the more notable amendments from Democrats, in order of their introduction:
While it is unlikely any of these measures get added to the bill, the process of adding many amendments could slow down the bill's passage and allow Democrats to express their displeasure with the AHCA.
The Energy and Commerce Committee is still marking up the bill, some 20 hours after kicking off the marathon session.
Sen. Tom Cotton, the influential Arkansas Republican, used Twitter on Thursday morning to express his displeasure with House Republicans' new healthcare legislation and the speed at which it was advancing through Congress.
"House health-care bill can't pass Senate w/o major changes," Cotton tweeted. "To my friends in House: pause, start over. Get it right, don't get it fast."
Numerous senators have expressed misgivings about the Republican replacement plan for the Affordable Care Act, the healthcare law better known as Obamacare. Some, including Sen. Rand Paul, of Kentucky, have criticized the law as not going far enough in its repeal. Others have worries about the future of Medicaid funding. The opposition has health-policy experts wondering whether the law can make it through the upper chamber.
Cotton's state of Arkansas is one of 34 states and the District of Columbia that went ahead with the Affordable Care Act's Medicaid expansion. That has allowed more than 11 million people nationwide to access Medicaid insurance and has become incredibly popular in the states where it has been expanded.
The new GOP bill, the American Health Care Act, would end the funding for Medicaid expansion in 2020 and shift to a per capita system of block grants that many experts say would result in less Medicaid funding for states. Additionally, the law would not allow anyone to be added to the expansion rolls after 2019, slowly decreasing the total number of Americans covered by Medicaid.
Cotton also said he was opposed to the fast track on which the bill was moving through the House. The AHCA was introduced Monday evening by the GOP leadership and is now being reviewed by committees before it goes to the House floor for a vote.
"GOP shouldn't act like Dems did in O'care," Cotton wrote. "No excuse to release bill Mon night, start voting Wed. With no budget estimate!"
Cotton was referring to the fact that the nonpartisan Congressional Budget Office has not released a score for the AHCA. The score gives estimates on the budget impact of the bill and how many Americans' health coverage would be affected.
Cotton is a longtime supporter of President Donald Trump, who has publicly supported the law and attempted to win over conservatives to get the law through Congress.
Despite this, Cotton made his opposition to the bill's existing form known Thursday.
"What matters in long run is better, more affordable health care for Americans, NOT House leaders' arbitrary legislative calendar," Cotton said.
Check out the tweets:
1. House health-care bill can't pass Senate w/o major changes. To my friends in House: pause, start over. Get it right, don't get it fast.— Tom Cotton (@TomCottonAR) March 9, 2017
2. GOP shouldn't act like Dems did in O'care. No excuse to release bill Mon night, start voting Wed. With no budget estimate!— Tom Cotton (@TomCottonAR) March 9, 2017
3. What matters in long run is better, more affordable health care for Americans, NOT House leaders' arbitrary legislative calendar.— Tom Cotton (@TomCottonAR) March 9, 2017
The insurance industry isn't convinced that the GOP's replacement for Obamacare will be a good thing.
America's Health Insurance Plans, a leading trade group of health insurers, critiqued elements of the Republican plan in a letter to House GOP leaders.
The AHIP, which represents insurers including Cigna, Allstate, Anthem, Aflac, and Humana, took time to praise some of the elements of the bill, the American Health Care Act, but had two major issues:
READ MORE: Here are the key aspects of the AHCA, and the major differences between it and Obamacare.
In addition to the AHIP letter, Blue Cross Blue Shield also offered a letter to Brady and Walden adding its critiques of the AHCP. The BCBS letter also focused on the tax credits and Medicaid expansion funding in addition to calling for further market-stabilization measures to protect the individual insurance markets.
While there is clearly some self-interest involved for the insurance companies, their influence may have some impact over the direction of the bill. Medical groups, conservative thinks tanks, and lawmakers from both parties have also brought up concerns about the AHCA.
CNN anchor Chris Cuomo expressed skepticism at House Democrats' attempts to slow passage of the Republican replacement of the Affordable Care Act.
On Thursday, the CNN anchor remarked that he did not think Democrats attempts on Wednesday night to slow down the markup process in the House Energy and Commerce and Ways and Means committees were effective.
"I was watching some of it last night. I did not hear better ideas coming out of the Democrats, I did not hear them scrutinizing the plan with facts and figures. They were just delaying and they were just saying this is wrong. Is that the tactic?" Cuomo asked guests on Wednesday's show.
Democrats are deliberately slowing down the new Republican bill — titled the American Healthcare Act — as Republican leadership attempts to rush the bill through before a congressional recess in April.
Regardless of House Republicans ability to push the bill through, it still faces hurdles in the Senate, where some conservatives remain opposed to the proposed tax credits to help Americans cover insurance costs.
For his part, Cuomo's influence in political media has grown significantly over the past year.
As interest in the new administration continues to boost television ratings, subscriptions, and online traffic, Cuomo and co-host Alisyn Camerota have seen their viewership skyrocket.
As Variety noted on Wednesday, viewership is up nearly 70%, while ad revenue rose 67% over the previous year.
Medicaid's chief medical officer on Wednesday night came out publicly against the healthcare bill proposed by House Republicans.
The decision to oppose the bill, the American Health Care Act, is a break from other leaders in the Department of Health and Human Services, which has shown support for the bill.
"Despite political messaging from others at HHS, I align with the experts from @aafp @AmerAcadPeds @AmerMedicalAssn in opposition to #AHCA," Dr. Andrey Ostrovsky tweeted.
Ostrovsky's account also tweeted out statements from the more than half a dozen medical associations that have opposed the bill.
Andy Slavitt, the former head of Medicare and Medicaid under the Obama administration, called Ostrovsky a hero.
House Speaker Paul Ryan on Wednesday night defended the House Republican leadership's efforts to repeal and replace the Affordable Care Act, the healthcare law better known as Obamacare.
During an interview on Fox News, host Tucker Carlson said the introduction of the GOP plan, called the American Health Care Act, "looks like chaos." Ryan took exception to the characterization.
"Well, actually, I don't think it really is chaos," Ryan said. "I heard what you said, but here's what we did a year ago. A year ago, House Republicans said, 'We need to take a plan to repeal and replace Obamacare to the country.' We spent a year working on this plan."
Republicans introduced the AHCA late Monday and brought the bill to House committees on Wednesday. The Ways and Means Committee approved the bill Thursday morning, and it is still being debated in the Energy and Commerce Committee.
Those moves, however, have come before the nonpartisan Congressional Budget Office has had the chance to score the bill to estimate its effects on the federal deficit and on Americans' health coverage. Additionally, numerous conservative Republicans have spoken out against the bill, saying it does not go far enough in its repeal of Obamacare. And moderate Republicans in the Senate have attacked the bill for changing federal funding to Medicaid. That has put the future of the AHCA in question.
Besides lawmakers, multiple conservative-leaning groups like Heritage Action, the Cato Institute, and the Club for Growth have attacked the AHCA. Medical groups including the American Medical Association have also expressed opposition to the plan.
Even the insurance lobbying group America's Health Insurance Plans — which represents major insurers including Anthem, Cigna, and Humana — has recommended changes to the law.
Ryan said most of these groups were against the bill because they didn't understand the technical proceedings of the replacement process. Since Democrats could block a bill that changes statutory parts of Obamacare using a filibuster, the GOP is using a narrow process called budget reconciliation that requires only a simply majority in the Senate.
"There's three phases here, and that's what a lot of outside groups and folks just don't understand the fact that if we put everything in the bill we possibly want, we would have a filibuster, we wouldn't be able pass it in the Senate," Ryan said. "So this bill, which is the first phase of a three-phase plan, is what we can pass without a filibuster in a budget bill."
Ryan went on to say that some members of Congress and interest groups didn't understand the process and that the House GOP leadership was working to avoid confusion.
"And it's that confusion that I think is running this issue," Ryan said. "But the point here is we're keeping our promises — we're excited about this."
In explaining the disagreements between GOP members over the bill, Ryan said it was a natural process of taking control of the presidency and both chambers of Congress.
"So, we are going through what I would call the sort of typical growing pains from being an opposition party fighting Barack Obama and Nancy Pelosi and Harry Reid to a governing party," Ryan said.
Watch the full interview from Fox News below:
Paul Ryan on Thursday went to new lengths to defend the House Republican bill to replace Obamacare.
Ryan rolled out a Panasonic television at the start of his weekly press conference and delivered a PowerPoint presentation identifying deficiencies of the Affordable Care Act, better known as Obamacare, to explain the process the GOP is using to overhaul the healthcare system.
The new tactic comes amid criticism of the new bill — named the American Health Care Act— by a variety of groups.
Conservative Republicans argue that the new legislation would not go far enough in repealing Obamacare. Moderate Republicans are worried the law's provisions on Medicaid funding would leave people without coverage in states that expanded the program. Democrats are concerned that the law would kick millions of people off their coverage.
Conservative think tanks have also criticized the law as "Obamacare Lite."Medical groups including the American Medical Association have also opposed the law, and the top interest group of the health-insurance industry offered changes it would like to see in the law.
Ryan has been on a media blitz to defend the law after these groups raised concerns, telling Fox News' Tucker Carlson on Wednesday night that the process was not in "chaos."
President Donald Trump also responded to unflattering reports surrounding the legislation's development Thursday.
"Despite what you hear in the press, healthcare is coming along great," he tweeted. "We are talking to many groups and it will end in a beautiful picture!"
While Ryan's presentation stuck mostly to Republican talking points that Ryan has covered before, the addition of the visuals brought a new element to what is becoming a wild first week of developments for the legislation.
President Donald Trump on Thursday said the process to replace the Affordable Care Act, known as Obamacare, is moving along just fine.
"Despite what you hear in the press, healthcare is coming along great,"Trump tweeted."We are talking to many groups and it will end in a beautiful picture!"
The tweet comes during a somewhat perilous first week for the GOP replacement.
The American Health Care Act was introduced on Monday evening and nearly immediately faced backlash. Conservative Republicans, moderate Republicans, Democrats, conservative think tanks, medical groups, and the insurance lobby have all offered critiques or outright rebukes of the new bill.
Trump, White House press secretary Sean Spicer, and Health and Human Services Secretary Tom Price have all said the White House supports the bill.
Trump even met with conservative groups, including the Club for Growth and Heritage Action, on Wednesday night to try and convince them to support the AHCA. Reports have also suggested that Trump plans to meet with conservative GOP opponents of the legislation to try and get them on board, as well.
House Democrats on the Energy and Commerce Committee staged a marathon fight to slow down the GOP's Obamacare replacement, but ultimately failed to stop the bill.
After a 27-hour delay, the Energy and Commerce committee approved the American Health Care Act in a party line vote.
The debate began on Wednesday at around 10:36 a.m. ET and concluded at roughly 2:02 p.m. ET on Thursday, running 27 hours and 26 minutes according to C-Span.
The bill will next be considered by the House Budget committee.
Democrats attempted to add amendments, including forcing President Donald Trump to turn over 10 years of tax returns in order for the bill to pass, delaying passage of the bill until the Congressional Budget Office scores it, eliminating changes to the funding of Medicaid expansion, and renaming the bill the "Republican Pay More For Less Care Act."
Another delay tactic Democrats used was to force clerks of the committee to read the 66-page legislation they were considering in its entirety. It took just over an hour.
While all of the Democrats' amendments were batted down by Republicans on the committee — the GOP outnumbers Democrats 31 to 23 on the panel — the tactic produced substantial delays.
The House Ways and Means committee also marked up the bill, but eventually passed it at around 4:30 a.m. ET Thursday morning in a party-line vote.
It's doubtful that the delay will do much to change or block the eventual passage of the law, but it could slow down the process enough for the score from the CBO — which would show the AHCA's impact on the budget and Americans' health coverage — to be released in the middle of the broader House debate. That score is expected some time next week.
President Donald Trump told conservative groups that if the GOP leadership's American Health Care Act did not pass, he would allow Obamacare to collapse and blame its failure on Democrats.
Trump revealed his strategy during a meeting with the conservative groups FreedomWorks, Club for Growth, Heritage Action, Americans for Prosperity, and the Tea Party Patriots at the White House on Wednesday. His comments were first reported by CNN's Jim Acosta and were confirmed to Business Insider by a source with knowledge of the meeting.
The first attempt at an Obamacare replacement supported by the House GOP leadership and Trump, the AHCA has faced opposition from conservative Republicans and organizations for not going far enough in repealing Obamacare.
Conservative groups say the AHCA's tax credits that allow people to purchase insurance are a "Republican entitlement" and the whole bill is simply "Obamacare Lite" or "Obamacare 2.0."
After the meeting, the heads of the various groups in attendance struck a conciliatory tone but still expressed concerns over the new bill.
"We shared our concerns with the bill, including the refundable tax credit, continued enrollment under Medicaid expansion, the likelihood of a 'doc fix' scenario of Medicaid expansion as it winds down in 2020, the continuous-coverage language, and remaining regulations in the bill," FreedomWorks' president, Adam Brandon, said.
"The concerns that have been raised by Sen. Paul, Sen. Lee, and members of the House Freedom Caucus are real, and we believe that we can negotiate on these provisions, address them in a substantive way, and get to 'yes' on this bill and throw Obamacare into the dustbin of history," he added.
David McIntosh of the Club for Growth said the president "listened" to the groups' concerns.
"The president wants to get something done, and he urged us to stay supportive," a statement from McIntosh said. "We laid out our major concerns about the lack of free-market reforms in this bill, the continuation of the Medicaid expansion, and the refundable tax credits."
At the same time, more Americans appear to have warmed to Obamacare, with polls showing the Affordable Care Act hitting its highest level of popularity ever.
Trump has long said allowing the law to remain unchanged would lead it to collapse, which would allow him to easily pass a replacement bill. The president said while that would be the politically easier path, he wanted to be proactive about a replacement.
Health-policy experts, however, have said Obamacare has not fallen under the technical definition of a "death spiral" that would indicate a collapse.
Paul Ryan used PowerPoint and a big computer monitor to defend the GOP's replacement for Obamacare, and people online replaced his screen with hilarious images. Here's a look at some of the memes that emerged after the event, including one from Rep. Keith Ellison.
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The House Republican leadership's American Health Care Act, which would overhaul large parts of the US healthcare system, was introduced this week after years of debate within the GOP. But it still has a ways to go to become law.
The bill will face some tough pushback from not only Democrats, but conservatives within the Republican Party, as well. Conservatives are angry that the bill still includes tax credits to buy insurance and have dubbed the law "Obamacare lite," while moderates are worried about potential cuts to Medicaid funding.
Add on opposition from conservative thinks tanks, medical groups, and insurance lobbyists and the AHCA could have a tough road to President Donald Trump's desk.
To get a sense of where we are in the process, we've created a handy checklist for the AHCA's passage to make it easy. Let's break it down.
House goes first
The first step for the AHCA came in the two committees that oversee healthcare matters. The bill was introduced to the House Ways and Means and Energy and Commerce committees on Wednesday, which started a long debate process.
Democrats tried to add amendments to the bill but were rebuffed by the Republican-controlled committees. The process also allowed Democrats to express their displeasure and delay it from moving forward — the Energy & Commerce Democrats, for instance, had the entire bill read aloud by committee clerks — but not stop it.
The Ways & Means committee eventually approved the bill at around 4:30 a.m. ET on Thursday, while the Energy & Commerce committee dragged on until around 2:20 p.m. ET.
The bill will next go to the House Budget Committee, which will consider it in much the same way the others did. If it approved by the Budget Committee (also Republican-controlled), it will move on to the House floor.
So, once the three committees have approved the bill and any amendments, it advances to the House floor for consideration. The full body will debate the bill and attach amendments, and then vote.
On to the Senate
If the bill is passed by the House, it will move on to the Senate.
In theory, Senate committees with jurisdiction over the bill could go through and do their own review and amendments process. Senate Majority Leader Mitch McConnell, however, suggested Wednesday that Republicans may take the bill straight to the full Senate floor for a vote. McConnell aides later clarified that this was only a suggestion.
The Senate could be the biggest hurdle for the proposed legislation. Conservatives such as Sens. Rand Paul and Mike Lee have said they will not support it because of the tax credits included in the bill, and because they argue it does not truly repeal Obamacare.
On the other end, senators in states that expanded the Medicaid program under the ACA, like Tom Cotton of Arkansas, have bristled at the AHCA's rollback of Medicaid expansion funding after 2019.
Since Republicans only hold 52 seats in the Senate, only a few defections would be needed to kill the bill.
If the Senate makes changes to the bill and passes it, but it differs from the House version, there would be another step added. A conference committee, made up of members of the House and Senate committees that oversee healthcare, would convene and craft a compromise bill.
This compromise bill would then have to be pass both the House and the Senate before the bill would go to President Donald Trump's desk.
Trump has said that he supports the AHCA, so he would likely sign it if it came to his desk in its current form.
The only real hiccup would be if an amendment or compromise is added that he does not favor. If that were the case, he could veto the bill, sending it back to Congress. Congress would need two-thirds of both the House and Senate to override the president's veto for the bill to become law. This would be unlikely, given Democratic opposition.