CFM’s federal affairs team keeps its clients informed about what’s happening in the nation’s capital, especially game-changing issues such as the Republican effort to carry through with political promises and repeal and replace the Affordable Care Act.
CFM Federal Affairs Manager Kirby Garrett provided a detailed alert to clients on activity leading up to a scheduled floor vote Thursday in the US House. He also provided a clear explanation of the narrow procedural lane Republicans must navigate under the Budget Reconciliation Act that limits issues to ones that cost money or are construed as a tax. Republicans are following this course to avoid a filibuster by Senate Democrats.
Garrett, a former senior aide to Oregon Congressman Greg Walden who helped write the GOP’s American Health Care Act (AHCA), describes the tenuous political situation for the legislation. The conservative Freedom Caucus in the House claims it has 27 votes against the bill, which would sink it assuming that all House Democrats vote against the Obamacare repeal measure. Freedom Caucus members say they won’t vote for a bill that doesn’t cut individual health insurance premiums. The Congressional Budget Office said the AHCA would result in higher premiums for the first two years before seeing premiums recede.
President Trump has summoned wavering House Republicans to the White House and, in coordination with House Speaker Paul Ryan, has agreed to some floor amendments, including one to boost the tax credits for older Americans in the 50-64 age group. However, it’s yet to be seen whether the concessions will be enough to assuage concerns, Garrett says, from conservatives, some GOP moderates and many Republican governors who worry about the bill’s impact on their state Medicaid programs.
In the update to clients, Garrett outlined what has come to be known as the three-bucket approach to repealing and replacing Obamacare. Assuming the AHCA makes it through Congress – bucket one, the second bucket would involve administrative action "to deregulate the marketplace, lower costs and stabilize the market.” Bucket three, Garrett explains, would require legislation "to let insurance companies sell policies across state lines, reform medical malpractice and associated health plans or pools for “high risk” patients that separate healthy people from those with serious medical conditions.”
His client update contained a section on Medicaid. “Cuts in federal Medicaid spending and a change in how states are reimbursed for Medicaid coverage have a much broader impact than on who may or may not lose coverage,” Garrett says. “Reducing federal spending on Medicaid by more than $800 billion would put more of the financial responsibility on states, many of which opted to take the Medicaid expansion offered under the Affordable Care Act, but aim to provide states broader discretion to implement the program."