Cathey Park of Cambridge, Massachusetts wears a cast for her broken wrist with "I Love Obamacare" written upon it prior to U.S. President Barack Obama's arrival to speak about health insurance at Faneuil Hall in Boston October 30, 2013. REUTERS/Kevin Lamarque

Details of potential Obamacare replacements by U.S. House Republicans emerged in news reports on Friday, as Republican lawmakers have vowed to introduce new legislation in the coming weeks.

Republicans have yet to agree on a single detailed policy proposal to repeal and replace the Affordable Care Act, the signature domestic policy of former Democratic President Barack Obama.

Still to be worked out are details including the future of Medicaid, the government health insurance program for the poor that was expanded in more than 30 states under Obamacare, and how a new healthcare law would be funded.

One emerging scenario among Republicans is that the millions of people who received health coverage through the expansion of Medicaid would be “grandfathered in,” according to the Washington Post. States that did not expand Medicaid could receive more money through increased federal “disproportionate share” payments used to help hospitals that serve a large number of uninsured patients.

And a draft Republican replacement plan for Obamacare, which news outlet Politico uploaded to its website, would cap the amount of money given to states for Medicaid and end tax subsidies based on income for the purchase of individual plans in 2020.

House staffers would not comment on the authenticity of the document, which was dated Feb. 10. President Donald Trump and Republicans have said they would present a plan for repealing and replacing Obamacare in the coming weeks.

It is not clear whether there is sufficiently broad support among Republican lawmakers for all of the measures in the draft proposal, or how the plans might change as they move through congressional committees.

The draft “addresses the major issues and is a serious proposal for transitioning out of Obamacare,” said Ed Haislmaier, a senior research fellow and healthcare policy expert at the Heritage Foundation who was on Trump’s transition team.

“Clearly the details will continue to evolve and we’ll be watching as they do,” he said in an emailed statement to Reuters.

U.S. health insurance executives, many of whom have lost hundreds of millions of dollars on the Obamacare individual insurance markets, are due to meet with Trump on Monday, according to a Bloomberg report. A Blue Cross Blue Shield Association spokeswoman confirmed it was invited to the meeting and will attend.

Republicans have repeatedly pledged not to “pull the rug out” from millions of Americans who gained access to healthcare under the law, and recent polls show more respondents favoring Obamacare than opposing it.

The Kaiser Family Foundation found broad bipartisan support for maintaining federal funding for the Medicaid expansion, with 84 percent of respondents saying it was important to do so, according to a survey released on Friday. The poll also found the law has record levels of support, with more Americans now viewing it favorably than unfavorably.

“Obamacare has failed. We welcome any and all efforts to repeal and replace it that put patients first,” said Caitlin Oakley, a spokeswoman for the U.S. Department of Health and Human Services.

Democrats decried the draft proposal on Friday and said it would cause millions of Americans to lose their health insurance.

“The deeply harmful path House Republicans have laid out would spell disaster for families nationwide,” U.S. Senator Patty Murray, a Washington state Democrat, said in a statement. “President Trump, who promised families he would provide insurance for everyone, should be the first to oppose it.” </s> WASHINGTON — Senate Republicans, who for seven years have promised a repeal of the Affordable Care Act, took a major step on Thursday toward that goal, unveiling a bill to make deep cuts in Medicaid and end the law’s mandate that most Americans have health insurance.

The 142-page bill would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment.

But the measure landed in rough seas ahead of a vote that Senator Mitch McConnell of Kentucky, the majority leader, wants next week. Four conservative senators, Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah and Ron Johnson of Wisconsin, announced that they would oppose it without changes — more than enough to bring it down.

“It does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs,” the four wrote in a joint statement. </s> A draft House Republican repeal bill would dismantle Obamacare subsidies and scrap its Medicaid expansion, Politico reports.

“The legislation would take down the foundation of Obamacare, including the unpopular individual mandate, subsidies based on people’s income, and all of the law’s taxes. It would significantly roll back Medicaid spending and give states money to create high-risk pools for some people with pre-existing conditions. Some elements would be effective right away; others not until 2020.”

“The replacement would be paid for by limiting tax breaks on generous health plans people get at work — an idea that is similar to the Obamacare ‘Cadillac tax’ that Republicans have fought to repeal.” </s> CHICAGO (CBS) — After President Donald Trump demanded a make-or-break vote on the Republican health care plan, lawmakers were expected to bring the legislation to the House floor Friday after a long night of closed-door meetings.

However, with several Republicans still expected to vote no, the GOP health care bill could be rejected.

House Speaker Paul Ryan (R-Wisc.) scheduled Friday’s votes after a meeting at the White House where the president said negotiations with Republican holdouts were over, and he would leave Obamacare in place and pursue the rest of his agenda if the health care plan fails. The president’s ultimatum came after the House postponed a planned vote on the measure Thursday afternoon.

“I think it was a helpful message,” U.S. Rep. Tom Cole (R-Okla.) said. “The president’s done everything he can to put us in a position to win.”

Ryan emerged from closed-door meetings late Thursday night sounding confident about the vote to repeal and replace former President Donald Trump’s signature health care plan, the Affordable Care Act.

“For 7 ½ years, we have been promising the American people that we will repeal and replace this broken law, because it’s collapsing and it’s failing families, and tomorrow we’re proceeding,” he said.

However, with U.S. Rep. Andy Biggs (R-Ariz.) announcing he plans to vote no, CBS News reports at least 35 House Republicans oppose the plan. With Democrats unanimously opposed to the GOP plan, only 22 Republican no votes are needed to reject it.

Many GOP lawmakers have been reluctant to support Ryan’s proposed American Health Care Act, which the Congressional Budget Office has said would leave 14 million fewer people without health insurance in 2018, and 24 million fewer without insurance over the next decade.

“We have to get it right, not get it done fast,” U.S. Rep. Charlie Dent (R-Penn.) said. “I thought the bill misses the mark and that’s why I’ve taken the position I’ve taken.”

Democrats also have ripped the AHCA as a $600 billion giveaway to the super-wealthy, referring to the tax cuts included in the plan.

“Let’s pull off the charade here, and expose what’s really going on. This is just another Republican tax cut for the rich,” U.S. Rep. Jan Schakowsky (D-Ill.) said.

U.S. Sen. Dick Durbin (D-Ill.) has said the Republican health care plan would cause hundreds of thousands of Illinois residents to lose health care coverage next year alone. </s> The House is debating and expected to vote Thursday afternoon on the latest Republican measure to repeal and replace the Affordable Care Act.

The bill includes last-minute amendments designed to draw votes from the most conservative House Republicans in the House Freedom Caucus as well as from their more moderate counterparts.

GOP leaders are hoping the third time is the charm for their measure. The original bill was pulled from the floor in March when it became apparent it would not pass. And last week, they considered but then decided not to risk another vote.

Republican members had their arms twisted by President Trump in phone calls, and attended a last minute pep rally Thursday morning, in which GOP House leaders reportedly told them it was "time to live or die by this day."

The measure, known as the American Health Care Act, is not expected to receive any support from Democrats, and so Republicans will have to come up with the necessary 216 votes to pass the bill and send it on to the Senate on their own.

House Minority Leader Nancy Pelosi calls the measure "a monstrosity," and said "Republicans have made Trumpcare even more dangerous and destructive than the last time they brought it to the floor."

House members will be voting on a bill without any knowledge of how many Americans will be affected, or the measure's price tag. That's because the Congressional Budget Office, the official scorekeeper, hasn't had a chance to analyze the amended bill. But the CBO estimated an earlier version of the measure would mean 24 million people could lose their insurance.

But we do know the bill would cut taxes imposed by the Affordable Care Act, and slash funding for Medicaid, which was expanded under the ACA, by more than $800 billion. It would also allow states to seek waivers for many of the patient protections in Obamacare, including for those with pre-existing conditions.

The measure does provide $8 billion for states to set up high-risk pools to cover people with pre-existing conditions who were unable to find affordable coverage on the open market. That last-minute addition was key to winning support from some House Republicans were concerned about coverage for pre-existing conditions. But critics say it's woefully short of the amount of money actually necessary to guarantee affordable coverage.

An array of medical groups, led by the American Medical Association, oppose the measure. In a statement, AMA President Andrew Gurman said "None of the legislative tweaks under consideration changes the serious harm to patients and the health care delivery system if AHCA passes. Proposed changes to the bill tinker at the edges without remedying the fundamental failing of the bill --that millions of Americans will lose their health insurance as a direct result of this proposal."

The retirees' group AARP also opposes the GOP bill.

But passing the measure would be a step toward keeping one of President Trump's central campaign vows, and fulfilling Republicans' long stated goal of overturning Obamacare, as the Affordable Care Act is also known.

Whether the Senate will go along is another story. Few Senate Republicans have expressed any interest in the House plan, and it's expected to be significantly altered if it reaches that chamber. And polls have shown the GOP measure to be extremely unpopular with voters, potentially placing at risk the political careers of lawmakers who back it. </s> Tom Price Confirmed As Secretary Of Health And Human Services

The Senate early Friday confirmed Rep. Tom Price, R-Ga., as the new secretary of Health and Human Services.

He was approved by a party-line vote of 52 to 47. Democrats were concerned that the conservative congressman wants to pare down government health programs. They were also troubled by lingering ethics questions over Price's investments.

In his new role, Price, a retired orthopedic surgeon from suburban Atlanta who served as chairman of the House Budget Committee, is expected to implement the repeal and replacement of the Affordable Care Act which his colleagues in Congress have been working on this year.

Price will oversee a $1 trillion agency, the largest budget of any Cabinet secretary. In addition to Obamacare, HHS administers the Medicare and Medicaid programs and oversees the National Institutes of Health, among other programs and agencies.

With Price's confirmation, HHS now has as its leader a budget hawk who has proposed replacing the Affordable Care Act subsidies that are tied to income, with tax credits to purchase insurance. Tax credits are not determined by an individual's income level.

Price also supports the proposal by House Speaker Paul Ryan to turn Medicare into what some call a "voucher" program. Under the plan, beneficiaries would receive "premium support" from the government to buy a Medicare health plan through an exchange. The private plans would compete against the traditional government-run program.

During his confirmation hearing, Price said his goal was that everyone have access to health insurance.

"What I commit to the American people is to keep patients at the center of health care. And what that means to me is making certain every single American has access to affordable health coverage," he said.

Democrats spent hours on Thursday reading stories from their constituents about how the Affordable Care Act helped them, and tried to make the case that Price is a threat to Medicare, Medicaid and health care for people who have ongoing medical conditions.

"Congressman Price's budget in the House cuts nearly $500 million from Medicare and turns it into a voucher program," said Sen. Bill Nelson, D-Fla., during the 30-hour debate.

The Obamacare replacement Price proposed included offering tax credits starting at $1,200 a year to allow people to buy health insurance, boosting the use of tax-advantaged health savings accounts and limiting the tax deduction companies take for providing health insurance to workers.

Those ideas are the core of what Republicans say they want to do to replace the ACA, but the details of how big the tax credits would be, and exactly how the HSAs would be structured are unknown.

During his confirmation, Price was dogged by questions about investments he made in health care-related companies.

Price says he followed all congressional ethics rules, but his well-timed trades made it appear that he could have used his position to influence the price of stocks he owned, or that he received special treatment from companies in which he invested.

Republicans in the Senate were satisfied with his explanations however, and the former congressman will be headed to his new office today. </s> CHICAGO (CBS) — Democratic Congressman Mike Quigley said Congressional Republicans have been at war with themselves over the replacement for the Affordable Care Act and the only real solution seems to be to stop trying to satisfy the GOP’s far right wing.

The Republican’s Freedom Caucus has demanded elimination of Obamacare’s standards for what health plans must cover, among other changes. That has soured some GOP moderates on the repeal legislation. WBBM Political Editor Craig Dellimore reports.

In the end, there were simply not enough Republican votes to approve the bill.

Even before the vote, Illinois Congressman Michael Quigley has said all along that even Democrats believe the Affordable Care Act should be changed, so this standoff could be resolved. He said the Republican lawsmakers could have made needed changes that are acceptable to Democrats, and they would not have to worry about votes from the most conservative members He says there would be enough votes “in the middle.”

“Obviously the people on the exchanges need more choices,” Quigley said. “And we can provide these choices by altering how we assess risk, modifying subsidies, increasing tax incentives. If they are willing to talk about that, they don’t have to worry about alienating the far right. They can have votes in the middle.”

Congressman Mike Quigley is the guest on our AT ISSUE program this weekend and you can hear more of his thoughts on a range of topics Sunday at 9:30 a.m. and 9:30 p.m. </s> That's a rhetorical question, of course. Republicans see that they have two choices: They can snatch health insurance away from millions of people, or they can replace Obamacare with something that looks suspiciously like Obamacare-with-a-different-name. Wary of both alternatives, erstwhile anti-ACA zealots have spent the first month of the Trump administration doing little more than clearing their throats.

The framework laid out by House Speaker Paul Ryan and other GOP officials last week is part capitulation, part evasion. In no way is it worthy of being called policy.

The surrender comes in the promise to keep the most popular features of Obamacare, which are a guarantee of coverage for those with pre-existing medical conditions and a provision ensuring that dependents can remain on their parents' insurance until age 26. Republicans accurately calculate that taking either of these benefits away would be politically suicidal — and that Trump, who has promised health care for "everyone," probably would balk.

The evasion — let's go ahead and call it dishonesty — is that the GOP framework promises not to "pull the rug out from anyone who received care" under the ACA's expansion of eligibility for Medicaid, the federal health insurance program for the poor. But Republicans also plan to change Medicaid into a program of block grants to the states, with sharp reductions in federal funding.

In effect, House Republicans threaten to force states to do the dirty deed and strike millions from the Medicaid rolls. Governors from both parties are not amused.

The fundamental lie of omission in the GOP's repeal-and-replace framework is the absence of any sense of what the new system would cost — or how it would be paid for. A plan without a budget is little more than a daydream.

Republicans do make clear that they want to eliminate Obamacare's direct subsidies designed to help the working poor afford insurance. Instead, they prefer a system of tax credits, based not on income but on age. A 50-year-old billionaire would receive the same amount of tax relief as his or her 50-year-old gardener. Anything that makes our tax system even slightly less progressive warms the hearts of today's GOP leaders.

But whether the federal government pays out more in subsidies or takes in less revenue because of tax credits, the reality is the same: Guaranteeing access to affordable health care is expensive. Republicans can decide it's too costly and throw people off the insurance rolls, but if they do they will pay a grievous political price.

Make no mistake, this has been a bad patch for the ACA. The chief executive of one health insurance giant, Aetna, opined last week that Obamacare has finally entered the "death spiral" that Republicans have so gleefully predicted. And officials of another mega-provider, Humana, announced that the firm will not participate in the Affordable Care Act exchanges in 2018.

That is called self-fulfilling prophecy: Republicans predicted from the start that Obamacare would fail — and then did everything they could think of to sabotage the program.

But in one crucial sense, the Affordable Care Act succeeded beyond anyone's wildest dreams: It fundamentally changed the nature of the health care debate in this country. Access to affordable health care is now seen as a right not just for the elderly and the desperately poor but for all Americans; and government is seen as the guarantor of that right.

The fact that Republicans pledge to continue protections for those with pre-existing conditions, dependents up to age 26 and the 12 million individuals covered by Medicaid expansion illustrates how things have changed. The GOP once fought these provisions tooth and nail, calling them socialism disguised as compassion. Now the party embraces core elements of Obamacare as the new normal.

House Republicans have been hearing from constituents who would be bereft without the insurance they obtained under the ACA. A couple of GOP senators have even begun talking about repairing the law rather than replacing it. And whatever Congress eventually comes up with will have to pass muster with Trump, who promised to expand health coverage, not reduce it.

Republicans will win the battle over the "Obamacare" label. But Barack Obama already won the war.

Eugene Robinson is a columnist for the Washington Post Writers Group. He can be reached at eugenerobinson@washpost.com. </s> WASHINGTON – House Democrats began making good on their campaign promise to shore up the Affordable Care Act Thursday, passing a bill that would bar the Trump administration from granting states some waivers to the landmark health-care law.

Next week, the House will vote on a package of seven health-care bills, several of which would reverse administration actions that Democrats have described as efforts to sabotage former president Barack Obama’s signature domestic achievement.

The votes come as President Donald Trump recently renewed his vow to repeal the 2010 law and directed the Justice Department to intervene in a lawsuit aimed at invalidating the law entirely – including its popular protections for Americans with preexisting medical conditions.

Trump has vowed to run on health care and has said his campaign would present a plan to voters. Republicans, however, have failed to come with an alternative to the law and there is no GOP effort in Congress to craft a replacement.

None of the House bills approach anything near the kind of massive expansion of government-run health care that a number of liberal Democrats are now advocating, including several of the 2020 presidential candidates. Instead, under Speaker Nancy Pelosi, D-Calif., House leaders are pursuing a measured strategy aimed at highlighting Democrats’ efforts to protect coverage for people with preexisting conditions without wading into the murky political waters of a Medicare-for-all-type plan.

“We invite it to be very bipartisan – send it to the Senate, and hope that the president of the United States, who says he supports [benefits for people with] preexisting conditions, signs it into law as soon as possible,” said Pelosi.

That appears to be a pipe dream. Though there was a faint glimmer of potential cooperation Thursday on a White House proposal to end certain surprise hospital bills not covered by insurance plans, the Democratic health care bills have sparse Republican support and none are expected to get consideration in the GOP-controlled Senate.

The Trump administration and GOP lawmakers have defended the expanded ACA waivers as a way to allow states to lower insurance prices. But Democrats say the practical effect will be to allow the sale of less comprehensive plans that could leave Americans vulnerable to coverage gaps.

The House passed the bill blocking the waivers, 230-183, with four Republicans joining all Democrats.

House Energy and Commerce Committee Chairman Frank Pallone Jr., D-N.J., said during debate Thursday that the short-term plans allowed under the administration waivers would undermine the viability of the more-comprehensive plans than many Americans with preexisting conditions rely on.

“The administration is giving insurers the green light to directly discriminate against people with preexisting conditions,” Pallone said. “It’s giving the green light for these plans to charge people with preexisting conditions more money. And it’s giving these plans the green light to refuse to cover any treatment that is related to someone’s preexisting condition.”

Republicans disputed that characterization Thursday, saying that despite the bill’s name – the Protecting Americans with Preexisting Conditions Act – the waivers it targets would not erode those protections. They argued that the administration could not waive the ACA’s provisions mandating that insurers sell policies to those with preexisting conditions.

“The misleading title of this bill confirms the Democratic majority position is to score political points instead of governing,” said Rep. Greg Walden, R-Ore. “They claim their agenda is for the people. Well, this bill is for the politics.”

Democrats retorted that, under the Trump waivers, Americans with preexisting conditions could be forced into an untenable choice: “Either stay in your ACA plan and see your premiums rise as healthy people move to cheaper, junk insurance,” said Rep. Tom Malinowski, D-N.J. “Or sign up for a junk plan yourself and risk getting gouged when the services you need aren’t covered. You end up with a two-tier health care system in America – one for healthy people, and one for sick people.”

The package of bills set for a vote next week includes some bipartisan bills aimed at streamlining the introduction of generic drugs in a bid to lower pharmaceutical costs. But it also includes more bills that seek to directly overturn administration health care moves.

One would reverse cuts to outreach and enrollment funding that was included as part of the ACA to help Americans as they sign up for health care through marketplaces or other government programs. Another would shore up the ACA’s navigator program, which provide grants to independent outside groups to help Americans enroll in insurance plans. A third would undo other administrative moves to allow for more of the loosely regulated short-term plans that many Democrats deride as “junk” insurance.

The most glaring threat to the ACA, however, is the pending lawsuit filed by Texas and 17 other GOP-led states. While the federal government is the defendant in that suit, the Justice Department earlier this year joined the plaintiffs instead in arguing the ACA is wholly unconstitutional and should be invalidated. Sixteen states and the District of Columbia have filed to defend the lawsuit.

The U.S. Court of Appeals for the Fifth Circuit on Thursday tentatively set oral arguments in the case for July 8, keeping it on track to remain a live issue throughout the 2020 presidential and congressional campaigns.

House Democrats voted last month on a resolution condemning the administration’s support for the lawsuit. In January, the House voted to authorize its lawyer to intervene in the lawsuit in support of the ACA.

Meanwhile, on the presidential campaign trail, Democratic candidates have largely moved to the left. While some have embraced the Medicare-for-all paradigm, including the possible end of private insurance, even centrist candidates have called for a “public option” that would be offered alongside private insurance plans – expanding the ACA well beyond its initial bounds.
A leaked memo from House Republicans reveals cutting provisions from Obamacare such as Medicaid expansions and subsidies for health insurance.