U.S. Rep. Westerman: ‘Good odds’ vote on health care will be this week

Congressional leaders hope to schedule a vote in the U.S. House of Representatives on the latest version of the American Health Care Act Wednesday or Thursday, and U.S> Rep. Bruce Westerman, R-Hot Springs, expects it to pass.

Westerman said he had lunch with House Speaker Paul Ryan, R-Wisc., Tuesday.

“He says we’re as close as we’ve been so far to having the votes, but we’re just a few votes short of having it, but I think there’s pretty good odds we’ll vote on it this week,” he said.

Multiple national press reports have detailed the difficulties facing House Republican leaders as they’ve tried to secure enough votes for passage with Democrats universally opposed. Westerman believes the bill will pass if it gets on the floor, “and then it can go over to the Senate, and the Senate can have their fun with it, and then it’ll come back for a conference after that. So it’s got a long ways to go to get on the president’s desk, but it absolutely has to get out of the House to keep the process moving.”

On March 24, Ryan cancelled a vote on the American Health Care Act (AHCA) because it lacked the votes to repeal and replace the Affordable Care Act (ACA), otherwise known as Obamacare.

The latest version contains an amendment by U.S. Rep. Tom MacArthur, R-N.J., that would keep the ACA’s ban on insurance companies denying coverage to individuals based on their “health status,” such as having a pre-existing condition. However, the amendment would allow states to obtain waivers allowing insurers to charge higher premiums based on health status if patients have let their health insurance lapse. Critics say that provision would allow insurance companies to price sicker patients out of the market.

House leaders say the cost issue would be addressed through high-risk pools or through a newly created Federal Invisible Risk Sharing Program that helps states reimburse insurers for the cost of high-risk consumers – again, provided they do not let their coverage lapse. Taking some of those high-risk individuals out of the normal insurance market would allow insurance companies to create cheaper products for everyone else, Westerman said.

In a letter to Ryan and Minority Leader Nancy Pelosi, D-Calif., the American Medical Association said the amendment does not ensure that the high-risk pools or reinsurance program would adequately cover those sicker individuals.

The American Health Care Act includes numerous other changes to the Affordable Care Act, as detailed in an analysis by the Kaiser Family Foundation. Insurers would be able to charge older ratepayers five times more than younger ratepayers, as opposed to the 3:1 ratio allowed under the Affordable Care Act. Meanwhile, states in 2020 could apply for waivers to let insurers offer different “essential health benefits” than currently must be included in every health plan under the ACA. The ACA’s ban on insurers setting lifetime and annual dollar limits would be retained, but it would apply only to those essential health benefits. Meanwhile, a number of ACA tax increases would be repealed, including a Medicare tax increase for high-income individuals.

The bill makes a number of other changes to the Affordable Care Act. It ends the tax penalty for consumers who fail to purchase a qualifying health plan while adding a 30% late enrollment penalty for individuals who let their coverage lapse. It ends the tax penalty to large employers who do not provide health coverage. It replaces the ACA’s income-based tax credits with age-adjusted credits that phase out at incomes between $75,000 and $115,000. It would increase the tax-free contribution limit to health savings accounts.

The AHCA also makes significant changes to Medicaid, including capping payments per enrollee. State programs could be funded via block grants for their nonexpansion populations and could require recipients to work. Medicaid funding for Planned Parenthood clinics would be banned for one year. The Congressional Budget Office estimated that the first version of the bill would reduce Medicaid spending by $880 billion from 2017-26.

The AHCA does not include a provision allowing insurance to be sold across state lines, a reform that cannot be pursued using the budget reconciliation process being used to advance the bill. That reform would have to be pursued through the normal legislative process.

The bill also does not change the ACA’s requirement that children up to age 26 be eligible for their parents’ insurance coverage.

The Congressional Budget Office and the staff of the Joint Committee on Taxation in March estimated that, under an earlier version of the AHCA, 14 million more people would have been uninsured in 2018 than under the ACA. That difference 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 version of 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.

Westerman said he supports the AHCA, saying he would like to see it passed by the House and moved to the Senate, where he hopes changes are made to its tax credits provision.

“It’s a pretty good bill the way it is right now,” he said.

Among the rest of Arkansas’ congressional delegation, U.S. Rep. French Hill’s spokesman, Mike Siegel, said the Republican congressman from Little Rock is waiting on the final version of the bill but generally supports it.

“There’s certainly no official timeline for a vote,” he said.

U.S. Rep. Steve Womack, R-Rogers, told Talk Business & Politics last week that he “leans yes,” a position his spokesman Beau Walker says he still holds.

The office of Rep. Rick Crawford, R-Jonesboro, did not respond to requests for comment, but the congressman has been a vocal opponent of previous versions of the American Health Care Act.