Revisions to initial GOP 'repeal and replace' plan didn't sit well with party moderates
By Karen Pallarito
FRIDAY, April 28, 2017 (HealthDay News) -- The Republican pledge to repeal and replace President Barack Obama's Affordable Care Act remains on hold.
The GOP had hoped to replace the health reform law with its own version, but those efforts broke down Thursday evening when it became clear there weren't enough votes in the House of Representatives to do so.
The White House had been hoping for a GOP victory with health legislation before Saturday, which marks President Donald Trump's 100th day in office.
House Speaker Paul Ryan told reporters that legislative leaders were making progress but added, "We're going to go when we have the votes," the Associated Press reported.
While revisions to an initial Republican plan won over conservative members of the so-called Freedom Caucus this week, those same changes proved unacceptable to more moderate members of the party, The New York Times reported.
For example, two moderate Republicans from Pennsylvania -- Patrick Meehan and Ryan Costello -- said they were concerned that the new bill would leave people with serious illnesses without sufficient insurance, the AP reported.
This isn't the first time Ryan has had to delay action on the GOP's "repeal and replace" promise concerning the controversial law sometimes called Obamacare. Last month, he had to cancel a vote on a first version of the proposed law due to opposition from conservatives in the House.
In the weeks following that setback, the White House and GOP leaders quietly worked on a compromise, one that tried to placate the party's conservative wing without alienating moderate Republicans.
The latest iteration included an amendment allowing states to opt out of certain Obamacare consumer protections.
The proposed amendment, circulated this week, explicitly banned insurers from limiting "access to health coverage" for people with pre-existing conditions. However, it did allow states to apply for waivers enabling insurance companies to charge sicker people higher rates for their health insurance.
States could also allow insurers to sell policies that exclude one or more of Obamacare's "essential health benefits."
Ed Haislmaier and Drew Gonshorowski, fellows at the conservative think tank the Heritage Foundation, on Wednesday applauded efforts to free states from "costly Obamacare mandates."
But, in a letter to Congressional leaders, American College of Physicians President Dr. Jack Ende this week said the proposed changes were a throwback to pre-Obamacare days, when people with pre-existing conditions were priced out of the market and insurance products did not cover medically necessary services.
It's unclear when House leaders plan to introduce an amended bill. And, even if it were to pass the House, it would still face tough Senate scrutiny.
By some accounts, Obamacare is on more stable footing today than it was a year ago.
Large losses on sicker-than-expected customers caused several big insurers to bail out of Obamacare or scale back offerings in 2017, while many others sharply raised premium rates to better account for the cost of providing coverage.
Deep Banerjee, a director and health insurance credit analyst with S&P Global Ratings, said that with some tweaks, but not a full repeal of Obamacare, "insurers, on average, will likely report close to break-even margins" for 2017. For 2018, insurers would be profitable, although margins would be low, he said.
"This is a fragile market and does need time to stabilize," added Banerjee, who spoke to reporters during a Commonwealth Fund briefing this week.
Of immediate concern is whether Congress will continue making billions of dollars in payments to health insurers for Obamacare coverage that reduces consumer cost-sharing.
Health care providers, insurance companies and business groups insist the payments are needed to stabilize the individual health insurance market for 2017 and 2018. But Obamacare opponents are urging lawmakers to pull the plug on the payments.
Subsidized cost-sharing is available to lower-income people (with incomes between 100 and 250 percent of the federal poverty level) who choose "silver" marketplace health plans.
More than 7 million Americans selected Obamacare health plans featuring lower deductibles, co-pays and out-of-pocket limits for 2017, said Sara Collins, vice president of health care coverage and access at the New York City-based Commonwealth Fund.
The U.S. Centers for Medicare and Medicaid Services has more on 2018 enrollment.
SOURCES: April 24, 2017, briefing with Sara Collins, Ph.D., vice president of health care coverage and access, The Commonwealth Fund, and Deep Banerjee, director and health insurance credit analyst, S&P Global Ratings, both of New York City; April 24, 2017, letter, America College of Physicians, Washington, D.C.; April 26, 2017, issue brief, Heritage Foundation, Washington, D.C.; Associated Press; The New York Times
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