Bloomberg) — House Speaker Paul Ryan doesn't plan to make major changes to Republicans' plan to de-funding the Affordable Care Act, according to a GOP aide, but the White House says it's talking with members of Congress who want to amend the legislation.
"We've always stated a willingness," Sean Spicer, White House spokesman, told reporters Tuesday in Washington. "Part of the reason we're engaging with these individuals is to hear their ideas."
Rep. Mark Meadows of North Carolina, chairman of the House Freedom Caucus and an opponent of Ryan's plan, said, "I think we're making real good progress with the White House and leadership, and I'm optimistic that we'll see some good results in less than a week."
Ryan and House Majority Leader Kevin McCarthy are speaking with President Donald Trump by telephone Tuesday afternoon to discuss the next steps.
House Republicans are in a bind following a Congressional Budget Office estimate showing that 14 million Americans could lose their insurance next year under the GOP ACA de-funding plan. The CBO gave a dire picture of the bill's effects heading into the 2018 congressional elections.
At the same time, insurance premiums will continue to rise in the near term, especially for older Americans. Starting in 2020, older, poorer Americans will have far less help from Republican tax credits than they get through Obamacare subsidies.
Rethinking the plan
Even as the Trump administration challenged the CBO estimate, concern is growing that the analysis suggests the party may need to rethink its plan.
Senators have largely focused on concerns that Medicaid provisions in the bill will limit states that expanded or want to expand the shared federal-state program, though with the CBO estimate they're also expressing worry about what will happen to the older and poorer people in their states who must purchase insurance on their own. Sen. John Thune, a South Dakota Republican, told reporters Tuesday he will seek changes to tax credits in House Republicans' plan to to help poor people.
"I do think we can tailor the tax credit in a way that makes it more attractive to people and more helpful to people on the lower end and with a phaseout that is a little less steep than what the House has," Thune said.
Sen. Pat Roberts, a Kansas Republican, told reporters he expects the bill will be changed considerably "not just to suit the Senate, it's to finally get to final passage and to help people."
The number of Americans without coverage would rise to 24 million in 2026 under Ryan's plan, bringing the U.S. uninsured rate to a record 19 percent, according to the nonpartisan CBO.
Older, poorer people will face the steepest decreases in financial help under Ryan's plan.
A 64-year-old earning $26,500 a year would have a $19,500 premium for health insurance and get a tax credit of $4,900, leaving a bill to pay of $14,600, the CBO estimated. That compares to a $15,300 premium under the ACA with a $13,600 subsidy, leaving the cost to the individual at $1,700.
"It is clear that this bill is not consistent with the repeal and replace principles for which I stand," Rep. Rob Wittman, a Virginia Republican, said in a statement Monday after the CBO estimate was released. "I do not think this bill will do what is necessary for the short and long-term best interests of Virginians and therefore, I must oppose it."
Wittman said he supports repealing the health law and will work with colleagues "on legislation that expands choices, increases access, and reduces costs."
HHS Secretary Tom Price says the CBO left out the effects of the changes HHS can make through the regulatory process. (Photo: Price)
'Take a pause'
Insurance premiums will be 15 percent to 20 percent higher over the next couple of years, before the GOP replacement plan goes fully into effect, the CBO estimated. They'd fall after that, thanks to more young people signing up and insurers offering skimpier coverage, the CBO says. In a decade, premiums are estimated to be 10 percent lower than they would have been under Obamacare, the CBO estimated.
