WASHINGTON — Two key House committees began formally drafting a repeal of the Affordable Care Act on Wednesday morning, even as the nation’s largest doctors’ group and a coalition of hospitals came out strongly against the Republican plan for replacing the law.
Leaders of the committees — Ways and Means, and Energy and Commerce — portrayed the replacement bill in their opening statements as one that would rescue Americans from health coverage that had grown far too expensive and limited, painting a dire portrait of the nation’s health care system under the signature domestic achievement of President Barack Obama. But Democrats immediately began building their case against the legislation, emphasizing its elimination of taxes on businesses and high earners that have financed the Affordable Care Act.
“This bill suffers from an identity crisis,” said Representative Richard Neal of Massachusetts, the top Democrat on the Ways and Means Committee. “Is this health care, or is this a tax-cut bill?”
Since congressional Republicans released the repeal-and-replace plan on Monday, a stream of medical and health advocacy groups, and AARP, have come out against it. Supporters of the bill so far are largely limited to those who would most directly benefit from its passage — groups that represent industries and individuals whose taxes would be cut, including the United States Chamber of Commerce and Americans for Tax Reform, a conservative anti-tax group.
On Wednesday afternoon, all major hospital groups, including the American Hospital Association, the Association of American Medical Colleges, the Catholic Health Association of the United States and the Children’s Hospital Association, came out against the Republican bill. “As organizations that take care of every individual who walks through our doors, both due to our mission and our obligations under federal law, we are committed to ensuring health care coverage is available and affordable for all,” they wrote. “As a result, we cannot support the American Health Care Act as currently written.”
The American Medical Association, which has nearly 235,000 members and calls itself “the voice of the medical profession,” sent a letter to leaders of the two committees on Tuesday saying it could not support the Republican bill “because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.” In particular, the group came out against a plan to replace the sliding, income-based premium tax credits provided under the Affordable Care Act with fixed credits based on age. The current system, it said, “provides the greatest chance that those of the least means are able to purchase coverage.”
America’s Essential Hospitals, which represents public and other hospitals whose patients are disproportionately poor, also criticized the Republican bill on Tuesday, saying its phaseout of the Medicaid expansion and its plan to change Medicaid financing to a fixed amount of money for each person in the program would harm its members and their patients.
Republicans have pressed forward, against the opposition not only of health care providers but their own conservative flank, which maintains that the bill leaves too much of the Affordable Care Act’s regulatory mandates in place.
Mr. Neal and other Democrats called Republicans irresponsible for moving ahead with consideration of the legislation before receiving estimates of how much it would cost, and how many people would lose coverage, from the Congressional Budget Office, the official scorekeeper on Capitol Hill.
As morning turned to afternoon, Republicans sought to keep the sessions focused on the idea that the legislation was a desperately needed solution to, as Representative Greg Walden of Oregon, chairman of the Energy and Commerce Committee, put it, “a government-run system that is in collapse.”
Representative Michael Burgess, Republican of Texas, described the Affordable Care Act as “a failed political and social experiment that ignored the will of people across the country.
But Democrats worked feverishly to portray the Republican bill as a reverse Robin Hood scheme that would devastate lower-income families while benefiting the rich. Representative Frank Pallone Jr. of New Jersey, the senior Democrat on the Energy and Commerce Committee, said the bill would produce “a giant transfer of wealth, taking from hard-working families and giving to the rich.” Moreover, he said, “billionaires will benefit, while Republicans dump huge out-of-pocket costs on working families.”
The Republican bill would roll back several tax increases imposed by the Affordable Care Act to pay for it, including a surtax on investment gains, a tax on medical devices and a tax on tanning salons. It would also delay a tax on high-cost, generous insurance plans that was intended to discourage overuse of the health care system.
But Democrats focused heavily on a provision in the bill that would give a new tax break to health insurance companies, allowing them to take tax deductions for executive compensation exceeding $500,000 a year. The Affordable Care Act barred deductions for salary and other remuneration over that amount.
When Congress was writing that law in 2009 and 2010, Democrats harshly criticized insurance companies, their profits, and salaries paid to insurance executives.
Mr. Obama said back then that insurance companies “pad their profits” while canceling coverage for the sick. Another provision of the health care law, in effect, capped insurers’ profits on Affordable Care Act business, requiring them to pay out a certain percentage of every premium dollar on medical claims and activities that improve the quality of care.
Lifting the cap on the compensation that can be deducted will cost approximately $400 million over a decade, according to an estimate from the Joint Committee on Taxation. Representative Brian Higgins, Democrat of New York, called the provision “morally reprehensible.”
At noon, after 90 minutes of opening statements and parliamentary skirmishes, Democrats on the Energy and Commerce Committee insisted on a reading of the Republicans’ repeal bill. Committee clerks began reading the full text of the legislation, including an increase in federal funds for community health centers and a one-year ban on Medicaid payments to Planned Parenthood clinics.
House rules and precedents generally require that a measure and proposed amendments be read in full. This reading is usually waived by unanimous agreement, but on Wednesday, Democrats on the Energy and Commerce Committee were in no mood to go along. They complained that the Republicans were rushing to approve the bill without following customary procedures.
Before the committee meetings got underway, Republican leaders emphasized that they expect an assessment from the Congressional Budget Office on the bill’s overall cost and impact on insurance before the House votes on the measure. Mr. Walden pointed out that the C.B.O. would have to change its conclusions to accommodate any amendments to the bill anyway. He said he “would almost guarantee” a score before the full vote.
The C.B.O.’s final grade is vital, not only because of its political weight but because Republicans are operating under special budgetary rules to protect the health legislation from a filibuster in the Senate. In order for it to pass the Senate with 51 votes — not the 60 needed to overcome a filibuster — the measure must save the government at least $1 billion over 10 years. If it costs the government money, Democratic opponents will easily be able to block it.
But at this point, no one knows the legislation’s cost.
Mr. Walden dismissed criticism that Republicans were rushing their bill through.
“It’s kind of funny,” he said. “In the first couple of months we were accused of moving too slowly and not having a plan. We’re doing this step-by-step, major process.”
House Republicans seemed optimistic they could overcome their disagreements.
“How can any Republican go home and say they voted against repeal and replace?” said Representative Chris Collins of New York, a member of the Energy and Commerce Committee.
BY : The New York Times