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Emerging GOP Plan Would Replace Parts of Obamacare as It’s Repealed

Ryan, Walden, Brady present plan that includes provisions that are controversial among some Republicans

House Speaker Paul D. Ryan told reporters Thursday that legislation to repeal the 2010 health care law would be announced after the Presidents Day recess. (Bill Clark/CQ Roll Call)
House Speaker Paul D. Ryan told reporters Thursday that legislation to repeal the 2010 health care law would be announced after the Presidents Day recess. (Bill Clark/CQ Roll Call)

Developing House Republican legislation to repeal the 2010 health care law would also include replacement provisions that are controversial among the GOP rank and file, like a refundable tax credit to help individuals purchase insurance and a plan for dealing with Medicaid expansion.

Speaker Paul D. Ryan, Energy and Commerce Chairman Greg Walden, and Ways and Means Chairman Kevin Brady on Thursday presented to the House Republican Conference their vision for a “repeal plus” bill that would undo most of the health care law and set up some pieces of a yet undeveloped Republican replacement. 

Ryan told reporters that the repeal and replace measure will be introduced after the Presidents Day recess. Asked if that meant the week of Feb. 27, the speaker demurred, saying that the bill’s drafters are waiting on cost estimates from the Congressional Budget Office and the Joint Committee on Taxation. “It’s after the recess … pending our drafting our issues,” he said.

The measure will start with the repeal bill the House and Senate passed in 2015, but will also include several replacement pieces, according to a source who was in the room for the presentation.

That includes the refundable tax credit, which would be available to people who don’t qualify for coverage through an employer or elsewhere so long as they are not purchasing a plan that covers elective abortions. The credit amount adjusts for age and family size.

Some conservatives have expressed concerns about using a refundable tax credit, saying it would create a new subsidy and the refundable nature of the credit makes it highly susceptible to fraud.

Another replacement piece in the repeal bill will be the GOP’s yet undecided plan for dealing with the health care law’s Medicaid expansion. The conference discussed some of the options, like block grants and per capital allotments, but has not yet made a decision on the best approach, according to the source.

The Medicaid expansion aspect of replacement is likely to be one of the more thorny issues the GOP has to debate, and there are no signs yet that Republicans are close to consensus on how to deal with it.

The repeal bill would also include provisions setting up high risk pools, which would help provide coverage for people with pre-existing conditions without driving costs up for everyone in the market, and expanding access to and use of health savings accounts, the source said.

Health and Human Services Secretary Tom Price was present for first half of the meeting, during which he spoke about the administration’s efforts to scrutinize regulations and take whatever administrative actions it can to mitigate what it sees as damage caused by the health care law, the source in the room said.

Price made clear that President Donald Trump wants to repeal and replace the law concurrently, saying, “The president is all in on this,” according to the source.

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