The House of Representatives is set to vote sometime Thursday on the Republican-written American Health Care Act, better known as "Trumpcare." Though it wasn't clear earlier this week if the GOP had the votes to get it through the House, Majority Leader Kevin McCarthy said Wednesday night that the GOP now has "enough" votes.
The core of the AHCA is age-based tax credits in lieu of the Affordable Care Act's taxes and subsidies, and a series of funding cuts to programs like Medicaid. The AHCA will also remove many of Obamacare's requirements on employers and insurance companies. When the House was first set to vote on the AHCA, in late March, the congressional Republicans' right flank spurred leadership to pull the vote, as neither hard-liners nor moderates had committed their support.
It now appears a compromise has been reached that will get the Republicans to 216 votes in the House, though getting the AHCA through the Senate will be a tall order. Here's some of what's in the newest version of the AHCA, as details emerge:
- Essential health benefits — Obamacare's list of things that every health insurance plan has to cover such as maternity care and prescription drugs — were at the center of the last AHCA debate. Ultra-conservatives in the Freedom Caucus wanted to cut many of them, and GOP moderates weren't willing to go along. A last-minute amendment to the new bill gives states the right to waive some of those required benefits, which could gut the coverage requirements of employer-provided health care plans nationwide and erase caps on out-of-pocket patient spending.
- Republican Reps. Fred Upton and Billy Long, who are in the party's more centrist wing, struck a deal for an extra $8 billion in funding to help offset the cost of "high-risk" insurance pools, in order to bring more centrist Republicans on board with the bill. These pools are for people with pre-existing conditions, who would otherwise be unable to get an affordable insurance plan. According to Democrats and most health care experts, the allotted $8 billion over five years is something akin to a band-aid on a broken leg.
- Among the new ailments designated as pre-existing conditions: rape, surviving domestic violence, having a Caesarian section, and postpartum depression.
- Medicaid would lose 14 million enrollees and $880 billion over 10 years — roughly 25 percent of its budget — according to estimates from the Congressional Budget Office.
- The AHCA would "defund" Planned Parenthood, effectively barring patients from using Medicaid dollars to get treatment at Planned Parenthood clinics.
- Another Medicaid consequence: School districts that use Medicaid reimbursements to pay the salaries of special education teachers would likely have to cut those positions or find new sources of funding.
- It is unclear whether all the Republicans planning to vote for the AHCA have actually read the bill.
- Pending New York state law requires health insurance plans to cover "medically necessary" abortions, while the AHCA prevents people from using federal tax credits to pay for plans that cover any abortion care. This could make it impossible for New Yorkers to use the federal tax credits.
- Many wealthy Republican politicians — including members of Trump's cabinet, Congress, and state governors — will greatly benefit from the repeal of a 3.8 percent tax on investment income for rich people that was part of the ACA, which helped pay for coverage for the poor.
- Members of Congress will be exempted from the AHCA, a loophole that Republicans say will be addressed in later legislation.