Late Monday, Republicans released the modified American Health Care Act, changed in negotiation after what they might call resistance but what I would call “yuge backlash”.
Dubbed “Obamacare Lite” by some – notably some members of the House Freedom Caucus – the President, the Speaker, and the Rules Committee met and negotiated with members of the House, and have presented their new version.
It’s a dud. Sorry.
First, here is part of the release from the Speaker’s office:
Today, the House Rules Committee – the fourth House committee to consider the American Health Care Act – posted two amendments to the legislation. The amendments include some purely technical revisions needed to comply with the Senate rules, as well as limited substantive changes, both those recommended by the House Budget Committee during its consideration of the bill and those proposed by House Republican members and the White House. The following is a statement from House Speaker Paul Ryan (R-WI) as well as a summary of the changes.
“The American Health Care Act is the result of a long, member-driven process, and these improvements are an extension of that inclusive approach. I want to thank the White House and members from all parts of our conference who have helped make this the strongest legislation it can be. With this amendment, we accelerate tax relief, give states additional options to spend health care dollars how they choose, strengthen what were already substantial pro-life protections, and ensure there are necessary resources to help older Americans and the disabled. With the president’s leadership and support for this historic legislation, we are now one step closer to keeping our promise to the American people and ending the Obamacare nightmare.”
Some members of the conservative House Freedom Caucus remain unimpressed. Critical, maybe, is a better word.
Chairman of the caucus Rep. Mark Meadows stated that they will not formally oppose the bill as a bloc vote, but he also offered this dire prediction:
Here’s more from the Speaker’s office:
The first amendment makes technical revisions to the original bill to ensure compliance with the Senate rules governing reconciliation bills. It is purely technical and achieves the same policy goals as previously drafted.
The second amendment includes improvements drafted by both of the authorizing committees.
Under jurisdiction of the Ways and Means Committee: Moves up repeal of Obamacare taxes from 2018 to 2017, strikes a provision allowing excess tax credits to be deposited into Health Savings Accounts, and provides budgetary space for the Senate to increase tax credits for older Americans.
Under jurisdiction of the Energy and Commerce Committee: Immediately prohibits any additional states from expanding the current broken Medicaid program, allows states to opt-in to a traditional Medicaid block grant as well as implement work-requirements for Medicaid, protects the equitable state-federal partnership, and enhances the growth rate for the aged and disabled population on Medicaid.
It has selling points. For example it “accelerates relief” on Obamacare’s taxes, moving the repeal from 2018 to this year. That means January of 2017, immediate tax relief. There are some changes to how states calculate Medicaid, as Avik Roy summarizes:
At the behest of House conservatives, the Manager’s Amendment contains new language giving states the option to take on a block grant instead of a per-capita allotment for their legacy Medicaid program. Republicans—and especially GOP governors—have long agitated for block grants that give them the flexibility to manage their Medicaid programs and modernize the design of Medicaid’s insurance benefit. This language gives them more flexibility than the original bill.
And the amendment allows for states to have work requirements for Medicaid benefits, under conditions. Those are the highlights.
The bottom line, though, is that it’s not being hailed as a game-changer. Not one to push it over the top. Rep. Meadows succinctly described the amendment as “Not sufficient.”
Speaker Ryan claims they’ve broken through and will have enough votes. Reps. Amash and Meadows are confident the votes aren’t there. It is unlikely there will be any significant “tweaks” before the vote on Thursday.
This doesn’t even begin to address the “still to come” problems like getting through the Senate, getting the other “phases” passed, and the rest of the pipe dreams.
It is, in other words, still a great big mess.
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