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 In a sign of deepening concern among Republicans about the bill's
future, Trump will speak to the party's lawmakers in Congress on
Tuesday about the healthcare overhaul, two House Republican aides
said.
The Republican leadership proposed a series of amendments that
marked major legislative changes, but it was not immediately clear
whether they would help win more Republican support amid solid
opposition from Democrats.
A leading conservative voice in the House, Representative Jim Jordan
of Ohio, is still opposed to the legislation even with the proposed
changes, according to an aide.
The administration and House leadership can only afford to lose
about 20 votes from Republican ranks. They need to shore up support
from moderate Republicans who fear the bill dismantling President
Barack Obama's signature Affordable Care Act will hurt millions of
Americans enrolled in the program.
However, Trump and Republican leaders must also appeal to hard-right
conservatives who believe the original bill did not go far enough in
repealing the law, prompting some to dub it "Obamacare Lite."
According to Republican sources who asked not to be identified,
House leaders will propose an approximately $85 billion fund for tax
credits to help people aged 50-64 get health insurance.
In an unusual move, the House proposed providing the Senate
flexibility to offer more help to that age group, which may need a
larger tax credit to help cover their healthcare costs - a move
aimed at winning over more moderate Republicans. It did not specify
how the Senate should do so.
Conservatives have opposed refundable tax credits, calling them
another entitlement program.
One amendment would dismantle most of Obamacare's taxes one year
earlier than initially proposed, in 2017 instead of 2018. That
includes both the individual mandate that requires everyone to
purchase health insurance or else pay a penalty, and the requirement
that employers of a certain size provide coverage.
The new language also addresses Medicaid, the federally backed
healthcare program for the poor and disabled that is one of the most
contentious aspects of the bill.
To appease conservatives, states would have the option of
implementing work requirements for able-bodied adults without
children or dependents. However, even the Heritage Foundation, a
powerful conservative group, has opposed such a provision.
In addition, states could decide whether to take per capita
allotments for their Medicaid programs or block grants for certain
populations. Both would drastically reduce federal Medicaid funding
from current levels.
Republican leaders hope to move the legislation to the House floor
for debate as early as Thursday.
DAMAGED PROSPECTS
At a rally in Louisville, Kentucky, on Monday night, Trump said he
wanted to add a provision to the bill that aims to lower
prescription drug costs through a "competitive bidding process."
"We're trying to add it to this bill and if we can't, we'll have it
right after," he said. During the presidential campaign, Trump
called for allowing Medicare to negotiate with pharmaceutical
companies, something the law currently prohibits.
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The Congressional Budget Office (CBO) analysis of the original House
Republican bill a week ago severely damaged its prospects. It said
14 million people would lose health coverage under the measure over
the next year and 24 million over the next decade.
The CBO is expected to update its analysis of the impact of the
legislation to take into account the latest changes being proposed.
Under the retooled legislation, the rollback of Obamacare's Medicaid
expansion, which provided states enhanced federal funding for new
enrollees, would be slowed.
More than 30 states, including about a dozen with Republican
governors, chose to expand their Medicaid programs under Obamacare.
Several Republican governors and key senators and House members have
expressed concern over abruptly cutting federal Medicaid funding and
therefore taking insurance away from millions of people.
Republican leaders are now proposing that many of those who gained
coverage under the expansion could keep it. The federal government
would maintain the higher funding levels for those up to 133 percent
of the federal poverty level. Obamacare expanded coverage to those
making incomes up to 138 percent.
Those beneficiaries could keep their coverage until they "cycle off"
the program, possibly because they would eventually make enough
money to purchase private insurance or obtain it through an
employer.
Another amendment would allocate more money for healthcare costs for
the disabled and elderly on Medicaid. The unusual mix of amendments
to Medicaid reflects leadership's attempt to assuage concerns from
both staunch conservatives and moderates.
Democrats oppose the Republicans' plan, which they say would throw
millions off health insurance and hurt the elderly, poor, and
working families while giving tax cuts to the wealthy.
Democrats as well as hospitals and insurers have urged Republicans
to consider how their plan would affect access to healthcare for the
20 million people insured by Obamacare.
(Reporting by David Morgan, Yasmeen Abutaleb, Susan Cornwell;
Additional reporting by Caroline Humer, Roberta Rampton and Richard
Cowan; Editing by Kevin Drawbaugh, Leslie Adler, Eric Beech and Paul
Tait)
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