On Thursday, amid reports that a new draft Affordable Care Act (ACA) replacement bill was available in a secret room open only to GOP members of a key House committee, Republican Sen. Rand Paul (Ky.) and several Democratic lawmakers went to hunt for it.
But on Friday, Politico published details of what it called "the latest" draft version, dated Feb. 24.
For the full political theatre and context, keep reading. To jump to details of the latest version of the House GOP's plan to repeal and replace the ACA, click here.
Why the GOP aimed to limit access to the bill
House Speaker Paul Ryan (R-Wis.) recently said he would like the House to pass an ACA repeal and replacement bill within three weeks and that President Trump would support the House's draft legislation. Republicans on the House Energy and Commerce Committee and Ways and Means Committee are scheduled to start debate on the as-yet-unfinished bill next week, Bloomberg reports.
In advance of those public debates, GOP lawmakers on the committees have been privately discussing proposals and sharing draft legislative language. Last Friday, a draft bill dated Feb. 10 was leaked to Politico and CQ Roll Call. That bill included provisions to transition Medicaid to a per-capita allotment model, replace the ACA's income-based premium subsidies with age-based tax credits, and eliminate the law's individual mandate, among other provisions.
In response to that leak, Bloomberg reported earlier this week that Republicans planned to treat a new draft bill "a bit like a top-secret surveillance intercept." It would be made "available to [Republican] members and staffers on the House Energy and Commerce panel starting Thursday, but only in a dedicated reading room," and no one could take copies out of the room, according to a GOP lawmaker and committee aide.
The hunt for the bill
On Thursday, Sen. Paul tweeted that he had "been told that the House Obamacare bill is under lock and key, in a secure location, and not available for me or the public to view." So he went to look for it in the nondescript room—H-157—where it was rumored to be held. Paul even brought a copy machine.
Paul was denied entry to the room and told the press, "We're here asking for written copy of this because this should be an open and transparent process." The senator, who has crafted his own ACA replacement plan, criticized the rumored draft House GOP plan as "Obamacare lite."
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Several Democratic lawmakers were also denied entry to H-157. Staffers then told Rep. Paul Tonko (D-N.Y.) there was no bill inside, which was confirmed by Ways and Means Chair Kevin Brady (R-Texas).
NPR's "Shots" reports that Energy and Commerce Committee Chair Rep. Greg Walden (R-Ore.) on Thursday did made a draft bill available for Republicans on the panel to read in a private room. However, Paul, Democratic lawmakers, and the press never found that room.
Despite the high drama, GOP approach is 'not unusual'
According to Modern Healthcare, it's common for lawmakers not to share many details of bill drafts while they are making deals to gain backing for their legislation. And the New York Times reports that it's "not unusual" for controversial legislation to be drafted by the party in the majority, "with little or no input from the minority."
Still, the drama is noteworthy because Republicans had criticized a closed-door approach to governing when Democrats controlled Congress. The Times reports that GOP lawmakers in 2009 and 2010 repeatedly accused Democrats of making "back-room deals" to pass the ACA and not giving the public sufficient time to review the law before its passage. And House Speaker Ryan this week told NBC's "Today" that Republicans are "not hatching some bill in a backroom and plopping it on the American people’s front door."
Draft bill details leaked
Despite GOP lawmakers' efforts to keep the bill text private while debate proceeds, Erin Mershon and Joe Williams of CQ News on Thursday reported several details of the latest proposal, as unveiled in a GOP conference meeting Thursday morning and at a meeting of Ways and Means Committee members later that day.
Based on conversations with GOP staffers and lawmakers, CQ reported that that the new plan "broadly resembles" the earlier draft that leaked to CQ Roll Call and Politico, but that some details, such as funding levels, had changed.
And while the old draft would have given states that expanded Medicaid under the ACA less money to cover their expansion populations, the new draft would indefinitely fund the enhanced federal matching rates that the ACA included for current enrollees, CQ reports.
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Then, on Friday, Politico's Paul Demko published details of what he called "the latest version of the House's Obamacare repeal bill"—a version dated Feb. 24; it was not immediately clear whether this represented the same draft reported on by CQ News. Demko wrote that "Republicans are still divided about several key provisions, and the bill is likely to undergo changes before being publicly released."
According to Demko, the new draft bill, like the old draft, would still:
- Replace the ACA's income-based premium subsidies with age-based tax credits;
- Transition Medicaid to a model in which the federal government would cap payments to states based on how many residents are enrolled in Medicaid; and
- Cap the tax exclusion on employer health plans to the 90th percentile of plan costs nationwide.
Demko reports that new draft, unlike the old draft:
- Wouldn't indefinitely allow "grandmothered" plans that do not meet coverage requirements to remain on the market;
- Would create a default federal "reinsurance" fund for states that do not use "state innovation grants" designed to increase the stability of individual health insurance markets. The reinsurance fund would reimburse insurers for patients with medical claims of at least $50,000 and up to $350,000; and
- Would require employed individuals to verify that they cannot access coverage through their jobs in order to receive tax credits.
Demko also reports that staff have been directed to propose ways to means-test premium tax credits, although no specific language had been added to the draft bill.
His reporting also conflicts with CQ's on one point: Demko writes that the latest draft "still includes a plan to phase out Obamacare's Medicaid expansion."
(House/John, Bloomberg, 3/1; Kliff, Vox, 3/2; House et al., Bloomberg, 3/2; Weigel, "PowerPost," Washington Post, 3/2; Phillips, "The Fix," Washington Post, 3/2; Pear, New York Times, 3/2; Kodjak, "Shots," NPR, 3/2; Demko, Politico, 3/3; Mershon/Williams, CQ News, 3/2 [subscription required]; Dickson, Modern Healthcare, 3/2).
ACA repeal or not, how can providers prepare?
The Trump administration and Republican-controlled Congress are moving forward with their plans to repeal and replace the Affordable Care Act, creating major new uncertainty in the health care industry. But how should providers prepare for what comes next?
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