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House Republicans have rolled out a large batch of changes to their bill seeking to repeal and replace the Affordable Care Act, the healthcare law better known as Obamacare.
The seven-page manager’s amendment adds numerous key provisions designed to shore up support for the bill, the American Health Care Act.
The move comes as House Speaker Paul Ryan, GOP leaders, and President Donald Trump’s administration try to lock down the necessary votes for the bill to pass the House.
Here’s a rundown of the key changes:
Move up the date of the Obamacare taxes repeal. Taxes that help fund the credits – on everything from healthcare executives making over $500,000 to tanning beds – would be repealed in 2017 instead of 2018. This appears to be an appeal to conservative House Republicans who say the law does not go far enough or quickly enough in its repeal of Obamacare. Allow states to create work requirements for Medicaid. While 77% of Medicaid beneficiaries are in households with a worker, Republicans have desired a provision that would allow states to mandate that nondisabled people be working to qualify for Medicaid. The new amendment would also increase the federal assistance for any state that institutes a work requirement by 5%. Federal exemptions would apply to people under age 19; heads of households under 20 who are in school or job training; pregnant women; single parents; and caregivers of children under 6 years old. States could also add their own exemptions. Allow states to shift Medicaid funding to a block-grant system. The original AHCA wording would shift funding for Medicaid expansion to per capita block grants, but the new provision would allow states to shift their funding for Medicaid to a simple block grant.
According to a press release by GOP leaders in charge of the amendment, it would also give the Senate the ability to expand tax credits for Americans ages 50 to 64.
“This change provides the Senate flexibility to potentially enhance the tax credit for those ages 50 to 64 who may need additional assistance,” a press release from the GOP leaders of the Energy and Commerce and the Ways and Means committees said.
According to the summary of the technical changes of the amendment, the tax-credit section of the AHCA would be eliminated “to accommodate the technical restructuring of the new tax credit made as a result of Senate guidance to maintain the privilege of the bill.”
At the same time, the amendment would lower the threshold for a tax deduction on medical expenses to 5.8% from 10%. The Congressional Budget Office would most likely score this as a savings of $75 billion to $85 billion.
Politico reported earlier Monday that this relief for older Americans would come in a the form of a $75 billion pool of additional tax credits, but that exact provision does not appear in the actual amendment. According to analysts, however, the savings from the tax exemption could be shifted in the Senate to make this happen, but it is not guaranteed.
The current flat-tax credit structure of the AHCA gives 50- to 59-year-olds $3,500 annually to help pay for insurance and people 60 years old and above $4,000 annually. Analysis by health-policy experts has suggested this would lead to a significant increase in premiums costs compared with the Affordable Care Act’s tax credits.
The moves come as Trump’s White House tries to wrangle conservative votes in the House and Ryan tries to persuade moderate Republicans to get on board.
Mark Meadows, the head of the conservative House Freedom Caucus, said before the package of changes that he had enough votes to block the law.
The House Rules Committee will consider the AHCA on Wednesday, and a full vote on the bill is expected in the House on Thursday.