Mark up for both the House Energy and Commerce (E&C) and House Ways and Means (W&M) committees will happen this morning beginning at 10:30 am. Both committees will consider the bills until they’re done and each committee is expecting around 100 amendments per committee. Highlights of the bill are below .
Big Items:
- It would convert federal Medicaid financing to a per capita cap beginning in FY 2020 based on FY2016 enrollment.
- It would reduce eligibility from 138% to 100% of FPL.
- It repeals all ACA taxes except for the Cadillac tax, which is delayed until 2025.
- It repeals Medicaid DSH cuts for non-expansion states beginning in 2018 and for
expansion states in 2020. Expansion states will not absorb cuts for DSH across all states. Rather,
the cuts will be divided across states, and expansion states will absorb only their share in 2018
and 2019. - It would retain coverage requirements like preexisting conditions, dependents up to age 26, preventative coverage, and prohibition on lifetime and annual limits.
- Tax credits to purchase coverage are reduced.
- It would repeal of the individual mandate (but insurers may charge a 30 percent higher premium for one year for individuals returning to the health care market after having been uninsured.
House and Senate Consideration
The House E&C and W&M mark up is today. After that, both parts will have to go to the House Budget Committee to be “married together” and more changes can be made. House Budget consideration could be as soon as Friday depending on when E&C and W&M finish. House Leadership will likely try to put the bill up for full consideration by next week.
From there, it will go to the Senate. The Senate will attempt to pass this via the Senate Budget Reconciliation process, which means that the Senate will consider this via a straight up or down vote — 60 votes are not needed. However, whatever the House passes, the Senate will change to conform to Reconciliation rules, so presumably McConnell can change the legislation enough to pacify some of these Senators and/or pick up Democrats like Senator Joe Manchin (D-WV), who represents a state where Trump is very popular.
There are restrictions in what the Senate can considered via Budget Reconciliation. Namely, there is a restriction called the Byrd Rule, which means, in overly simplistic terms, provisions considered in a budget bill have to be related to cost or spend money; they cannot legislate. Why is this important? There are items in the House draft, such as Section 103 in the E&C draft (the provision defunds Planned Parenthood) that will be struck from the Senate’s version by virtue of the fact that these provisions legislate.
While officially, the Senate should do as the House and send the bill to the companion Senate committees (HELP, Senate Finance, and Senate Budget), there is a push to have McConnell move this straight to the Senate Budget Committee or Senate Floor. Regardless, this legislation will move quickly in each legislative body.
The goal is to have the whole bill passed and signed before Congress leaves for a two-week Easter Recess on April 7th.
In the mean time, the Congressional Joint Committee on Tax has estimated this will cost $500 B over the next 10 years due to all of the ACA taxes repealed — all ACA taxes are repealed but for the the Cadillac Tax, which is delayed until 2025. There still is no CBO score, which would include an accounting of all revenue lost as well as the number of people losing coverage. A CBO score isn’t expected until after the measure is considered by the House.
Politically
Conservative political groups are blasting the measure already. The Club for Growth, Heritage Action, FreedomWorks, and Americans for Prosperity have all been very critical of the measure and have the ear of conservative Members. Other groups, such as AARP, have also come out against the bill.
The Office of Federal Relations will continue to track the legislation and continue to provide updates.