Health Care Reform Update from the National Association of Health Underwriters as of 3/17/17:
“The House Budget Committee held its hearing on the American Health Care Act (AHCA) on Thursday, narrowly approving the bill by a vote of 19-17. All Democrats voted against it and were joined by three Republicans, Representatives Mark Sanford (SC), Dave Brat (VA) and Gary Palmer (AL), who are members of the House Freedom Caucus. The committee was tasked with bringing together the various portions of the bill that had been split by the House Energy and Commerce and Ways and Means Committees last week. With the Budget Committee’s approval, the bill now heads to the House Rules Committee, likely next Monday or Tuesday, after which it can be considered on the House floor. According to the current timeline, the House is expected to hold a floor vote on the bill next Thursday. The bill will need 216 votes for passage in the chamber, a majority of the chamber’s current 430 voting members (there are five vacancies—four seats previously held by Republicans and one by a Democrat).
While it was not able to make substantive changes to the bill, the Budget Committee was able to make several non-binding recommendations. The committee voted 27-8 to approve a recommendation for the bill’s tax credits to be changed to provide more support for poorer and older enrollees. By a vote of 21-12, the committee also approved a proposal to allow states to accept Medicaid block grants. Representative Todd Rokita (R-IN) introduced the measure to help improve state flexibility as the AHCA bill text currently shifts Medicaid to a per-capita basis, which many conservatives have criticized that the federal government would still remain too prescriptive of how the funds were to be used.
Another item the committee considered was to preserve Planned Parenthood funding, which the AHCA as written would defund. That measure failed by a vote of 21-14, with Representative John Faso (R-NY), one of the more moderate Republicans, voting with the committee’s Democrats. At least two senators, Susan Collins (R-ME) and Lisa Murkowski (R-AK), have publicly stated that they will not support the AHCA if the organization is defunded. Senate Republicans can only afford to lose, at most, two votes for passage in the chamber as they hold 52 seats and need 51 votes for passage. Under a tie, Vice President Mike Pence would cast the 51st and tie-breaking vote for passage.
The non-binding measures are means to help appease many of the more conservative members of Congress who often buck the Republican Party on principle. The House Freedom Caucus includes three-dozen members, and Representative Mark Meadows (R-NC), who chairs the caucus, said this week that he is ready to have his group vote down the bill if their demands are not met, such as a quicker phase-out of the Medicaid expansion. The House has been holding meetings with their Senate counterparts to determine which elements of the bill would need to change to appease enough members to pass both chambers. This included a meeting with Representatives Kevin Brady (R-TX) and Greg Walden (R-OR), and Vice President Mike Pence and HHS Secretary Tom Price.
Several conservative members of the Senate met at the White House this week to discuss their issues with the AHCA. Senator Mike Lee (R-UT), who chairs the Republican Steering Committee, along with Senators Rand Paul (R-KY), James Lankford (R-OK) and Ted Cruz (R-TX) relayed their concerns over the bill’s tax credits creating a new entitlement program, which is a concern also shared by the House Freedom Caucus. Senator Lankford has called the tax credits far too generous and said, “If we don’t get things right, we should not move [the bill].” Senator Tom Cotton (R-AR) urged House Republicans not to vote for the AHCA as currently written because the Senate will not pass it, and that would cement their votes in favor of legislation that would lead to “adverse consequences for millions of Americans and wouldn’t deliver on promises to reduce the cost of health insurance to Americans.” “