- Eliminate the individual mandate that requires most Americans to have health insurance or pay a penalty;
- Allow parents to keep kids on their health insurance until the age of 26;
- Allow states to continuing enrolling people under Medicaid expansion through the end of 2019;
- Expand the amount individuals and families can contribute to Health Savings Accounts; and
- Eliminate cuts to federal funding for hospitals in non-Medicaid expansion states that help offset the cost of caring for uninsured patients.
The Department of Health and Human Services also previously announced regulation changes aimed at helping to bolster the Obamacare insurance exchanges, including making the open enrollment period shorter.
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It wasn't immediately clear Monday how much the bill would cost if passed and how exactly it would affect those who signed up for 2017 Obamacare coverage through the exchange. Insurers offering exchange coverage have said they will keep 2017 plans intact.
The future of the exchanges is also murky at this point. Insurers must notify states this spring whether they plan to continue offering coverage on the exchanges. Major insurers, including UnitedHealthcare and Aetna, have already dropped out of many Obamacare markets throughout the country, citing losses in the tens of millions of dollars because their customer base turned out to be sicker and more expensive than anticipated.
The road ahead is a treacherous one for Republican leaders on Capitol Hill, and the problems start on their own bench.
Conservatives are under pressure from groups such as Heritage Action and the Koch brothers-owned Freedom Partners to reject the bill because of its tax credits, which critics say is akin to creating a new entitlement program.
A new fissure opened earlier Monday when four Republicans from states that expanded Medicaid vowed to vote against any legislation that doesn’t shield people who became eligible for health care coverage under the expansion of the entitlement program.
“Reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals,” GOP Sens. Cory Gardner of Colorado, Lisa Murkowski of Alaska, Rob Portman of Ohio and Shelley Moore Capito of West Virginia wrote in a letter to the chamber’s leadership.
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Some 31 states, as well as the District of Columbia, have adopted Medicaid expansion – extending health care coverage to millions of poor Americans.
It is imperative for top Republicans to keep their ranks together if they want to kill Obamacare. Senate leaders can afford only two GOP defections to keep such legislation alive in the chamber and House Speaker Paul Ryan can lose 19 in the face of united Democratic opposition.
Minutes after the legislation was made public, U.S. Sen. David Perdue, R-Ga., indicated he was cautiously optimistic about the plan.
“I’m excited that they’re beginning to expose some of the thinking behind this,” he said in a brief interview near the Senate chamber. “We don’t have all the pieces to it yet, obviously, but the mandates — that’s a no-brainer … I’m going to wait and see the rest of it.”
Democratic opposition was swift.
“The Republican repeal bill would rip health care away from millions of Americans, ration care for working families and seniors, and put insurance companies back in charge of health care decisions – contrary to everything President Trump has said he would do with his health care plan,” said Reps. Frank Pallone of New Jersey and Richard Neal of Massachusetts, the top Democrats on the House Energy and Commerce and Ways and Means committees, the panels that will assess the legislation later this week.