Obamacare repeal pulled for lack of votes; unclear if or how soon Congress will tackle healthcare

Lacking the votes for passage, Republican U.S. House leaders pulled the bill that would repeal and replace Obamacare shortly before it was scheduled for a Friday (March 24) vote.

Republican lawmakers were called into conference at about 2:30 p.m. CST shortly before the vote on the American Health Care Act (AHCA) was scheduled, where they were informed the bill would be pulled. Speaker of the House Paul Ryan, R-Wisc., said in a press conference afterward that he had told President Donald Trump the bill should be pulled, and Trump agreed.

“We were close but not quite there,” Ryan said.

Asked if Republicans would try to prop up the Affordable Care Act (ACA), otherwise known as Obamacare, Ryan said the current law cannot survive. He later said the law is collapsing and will get worse, but Republicans would move on to other parts of their agenda.

“I don’t know what else to say other than Obamacare is the law of the land,” he said. “It’s going to remain the law of the land until it’s replaced. We did not have quite the votes to replace this law, and so, yeah, we’re going to be living with Obamacare for the foreseeable future. I don’t know how long it’s going to take us to replace this law.”

Until the latest move, Trump, Ryan and other supporters of the bill had pressed their fellow Republicans to support the AHCA, negotiating and wooing the conservative Freedom Caucus who said it didn’t go far enough in repealing Obamacare and moderates who feared their constituents would be harmed. Ryan said the Freedom Caucus opponents were enough to sink the bill.

On Thursday, Trump declared that a vote would be held Friday regardless of the vote count, with the ACA to remain if the bill failed. Democrats were united in their opposition.

ARKANSAS CONGRESSIONAL DELEGATION SPLIT
The bill has divided the members of Arkansas’ congressional delegation. U.S. Reps. French Hill, Steve Womack and Bruce Westerman announced their support, and Womack and Westerman voted to advance it out of the House Budget Committee March 16 on a close 19-17 vote. But U.S Rep. Rick Crawford announced his opposition to the bill, saying it did not do enough.

Crawford issued this statement after the bill was pulled: “I support the President and Speaker Ryan’s decision to take additional time to get health care reform right instead of right now. Largely, Arkansans want health care reform that eliminates failed policy and starts from scratch. The American Health Care Act (AHCA) made some changes, but ultimately the new bill maintained Obamacare’s overall structure and approach, an approach that cemented the federal government’s role in health insurance. The ACHA also didn’t address core problems facing Arkansans, like health care access and rising premiums and deductibles.”

In the Senate, U.S. Sen. Tom Cotton, R-Ark., on March 12 told ABC’s “This Week” that the bill could not pass the Senate, asserting it would adversely affect millions of Americans and wouldn’t reduce the cost of health insurance. Meanwhile, it would put the House majority at risk.

“I would say to my friends in the House of Representatives, with whom I served, do not walk the plank and vote for a bill that cannot pass the Senate and then have to face the consequences of that vote,” he said.

U.S. Sen. John Boozman, R-Ark., told Talk Business & Politics in an interview broadcast March 12 that the process should be slowed.

“The thing that’s so important is lowering the cost curve, making things affordable,” he said. “So many people in Arkansas have had their premiums doubled, so many are in situations with $5-10,000 deductibles. That’s not insurance. That’s catastrophic insurance and is really not acceptable.”

Gov. Asa Hutchinson’s spokesman, J.R. Davis, said Friday the governor recognizes this is a multi-step process and is supportive of Congress’ efforts to repeal and replace the ACA.

“The governor is eager to work with Congress and the administration to improve the bill and allow for final passage,” he said.

Gov. Hutchinson issued this statement late Thursday afternoon: “I have no doubt Congress will revisit this issue and ultimately agree on a replacement for ACA. In the meantime, we will continue with our waiver request to strengthen the reform under Arkansas Works.”

LEGISLATION SUMMARY
The bill would have ended the ACA’s mandate that individuals buy health insurance and the mandate that larger employers provide insurance to their employees. People who left the individual market would have been charged a 30% penalty if they repurchased insurance.

It would have provided tax credits based on age rather than income, as does the ACA. States, rather than the federal government, would have defined the essential health benefits each insurance plan must provide. It also would have prohibited funding to Planned Parenthood for one year.

The AHCA would have continued until 2020 the ACA’s already enacted expansion of Medicaid benefits, which led to the creation in Arkansas of the private option, now known as Arkansas Works, which purchases private health insurance for Arkansans with incomes up to 138% of the federal poverty line. In 2020, federal funding would have been capped per enrollee based on state expenses in 2016. States could have imposed work requirements for some Medicaid beneficiaries and could have chosen to receive Medicaid funding in block grant form.

WINNERS AND LOSERS
Arkansas Advocates for Children and Families released estimates Friday that 196,800 nonelderly Arkansans would have lost health insurance coverage if the bill were enacted into law, divided roughly evenly between the state’s four congressional districts. That would have included 68,900 Arkansans now covered under Arkansas Works. AACF’s estimates were based on the Congressional Budget Office’s projected effects of the bill along with data from the Kaiser Family Foundation, U.S. Census Bureau, and the Centers for Medicare & Medicaid Services.

The Arkansas Center for Health Improvement released data showing that whether an individual won or lost with the AHCA depended on age and income. A 27-year-old with an income of $20,000 who receives a tax credit of $2,680 under the Affordable Care Act would have received $2,000 under the AHCA, resulting in a loss of $680. A 40-year-old making a similar income would have seen the tax credit drop from $3,480 to $3,000. The big loser would have been a 60-year-old making $20,000, whose tax credit would have fallen from $8,470 to $4,000.

But Americans ages 27 and 40 making $40,000 would have seen their tax credits increase by $2,000 and $2,640, respectively, while Americans earning $75,000 a year and above would have received tax credits after receiving none under the ACA. The big winner would be a 60-year-old earning $75,000, who would have seen tax credits rise from nothing to $4,000.

The Congressional Budget Office and the staff of the Joint Committee on Taxation on Thursday estimated that 14 million more people would have been uninsured in 2018 under the AHCA than under the current law, a difference that would have risen to 21 million in 2020 and 24 million in 2026. By that year, 52 million Americans under age 65 would not have had insurance under the AHCA, compared to 28 million under the ACA. Meanwhile, the report estimated that the AHCA would have reduced annual federal deficits by $150 billion from 2017-26, meaning the federal government would still have added to the national debt, though not as much. An earlier version of the bill left the same number uninsured but would have reduced deficits by $337 billion over that time period.

Opponents of the bill from the left, right and elsewhere criticized the bill for various reasons. On Friday, the Arkansas chapter of the American Academy of Pediatrics announced its opposition, saying the AHCA would harm Medicaid and would not make coverage more affordable for families. The conservative group Americans for Prosperity previously announced it would create a “seven-figure fund” to support lawmakers who opposed the plan, saying it didn’t repeal Obamacare and make insurance more affordable.

The U.S. Chamber of Commerce supports the bill, saying it would repeal Affordable Care Act taxes and penalties.