Despite attempts by Democratic lawmakers to stall the debate, House GOP lawmakers early Thursday morning took the first steps to advance legislation that would repeal and replace the Affordable Care Act (ACA).
House Republicans unveiled the plan, called the American Health Care Act (AHCA), on Monday. Lawmakers then divided the legislation into two parts for House Ways and Means Committee and the House Energy and Commerce Committee to mark up separately.
Those markups began Wednesday morning and stretched long into the night. Finally, at 4:30 a.m. ET Thursday, the House Ways and Means Committee advanced their portion of the plan. The House Energy and Commerce Committee at the time of publication was still working on a separate markup of its portion of the legislation—26 hours after its hearing started.
Republicans aim to approve the full measure this week, which would allow the full House to act on the measure before Congress begins its spring recess on April 7, Modern Healthcare reports. The legislation would:
- Delay the implementation of the ACA's so-called "Cadillac tax";
- Eliminate the ACA's individual and employer mandates;
- Expand tax breaks for health insurers, increasing the cap on tax deductions for insurance executives' salaries from $500,000 to $1 million;
- Increase use of health savings accounts;
- Repeal the ACA's medical device tax; and
- Repeal the ACA's taxes on health plans and brand-name prescription drugmakers.
Stakeholders have expressed mixed reaction to the proposed bill, with some business groups praising the bill, while organizations representing doctors and hospitals say it is critically flawed.
House Ways and Means Committee advances bill
After nearly 18 hours of debate, the House Ways and Means Committee early Thursday morning voted along party lines 23-16 to advance the portion of the AHCA referred to its committee, which related to tax provisions. Republicans on the committee voted for the measure, while Democrats voted against it.
In their attempts to delay the markup, Democrats offered amendments to the legislation that would have:
- Barred the bill from taking effect if it increased U.S. deficits or uninsured rates;
- Barred the bill from taking effect if CBO determined that it would increase rates of uncompensated care or cause hospitals to cut jobs;
- Blocked the bill from increasing taxes on families with annual incomes of $250,000 or less;
- Required the bill to be publicly available for 72 hours before a vote could be held on the legislation and forced voting members to submit a statement vowing they read the entire AHCA; and
- Required President Trump to release his income tax returns.
The committee rejected all of the amendments offered by Democrats.
House Ways and Means Committee Chair Kevin Brady (R-Texas) called the panel's meeting "long but fruitful." He added, "This is a historic step, an important step, in the repeal of Obamacare, and freeing millions of Americans, patients and local businesses from that pain."
Democrats criticized Republican lawmakers for holding the discussions in the middle of the night. Rep. Richard Neal (D-Mass.), the top Democrat on the Ways and Means Committee, said, "Here we're are at almost 2 o'clock in the morning taking a vote when the American people have gone to sleep."
House Energy and Commerce Committee keeps working
Meanwhile, the House Energy and Commerce Committee debated portions of the measure related to consumer protections, as well as a provision that would phase out the ACA's Medicaid expansion.
Democrats at the meeting offered numerous amendments to the bill in an effort to stall the committee's markup. The panel has so far voted down all of those amendments, including measures that would have:
- Barred insurers from charging older enrollees more for premiums than younger enrollees;
- Eliminated a provision in the bill that would change Medicaid to a per-capita allotment model;
- Eliminated a provision in the bill that would halt certain federal funding for Planned Parenthood;
- Eliminated a provision in the bill that would repeal the ACA's cost-sharing payments; and
- Renamed the bill as "The Republican Pay More for Less Care Act."
In another move to delay the markup, Rep. Ben Ray Luján (D-N.M.) requested that the committee's clerk read the bill's entire text out loud.
Democrats' efforts to delay the proceedings have forced the session to run for more than 26 hours.
According to Politico Pro, if the Energy and Commerce Committee advances its portion of the legislation, the AHCA would face two more markups before it can head to the House floor.
(Golshan, Vox, 3/9; Nather, "Vitals," Axios, 3/9; Dickson/Meyer, Modern Healthcare, 3/9; Alonso-Zaldivar/Fram, AP/Sacramento Bee, 3/9; Dinan/Howell, Washington Times, 3/9; Marcos, The Hill, 3/8; Kaplan et al., New York Times, 3/9; Cancryn, Politico Pro, 3/8 [subscription required]; Cancryn , Politico Pro, 3/9 [subscription required]; Cancryn , Politico Pro, 3/9 [subscription required]).
What you need to know about the House GOP's repeal and replace plan
Our experts have dug into the GOP's new plan to understand how it will affect you, including its potential big changes to the individual insurance market and Medicaid program.
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