As markups commence on the American Health Care Act, all eyes will be on Republican federal lawmakers and whether they will heed divergent concerns on how to best ensure low-income individuals will have access to healthcare coverage.
The American Health Care Act unveiled on Monday and set for two markups in the U.S. House of Representatives includes controversial proposals to repeal Affordable Care Act reforms that received support from federal and state lawmakers.
The newly proposed bill eliminates the ACA's individual mandate, ends funding for Medicaid expansion after 2020, converts Medicaid to a per capita cap program and provides health savings account tax credits to help people purchase insurance.
The House's Energy and Commerce and Ways and Means committees will mark up the bill Wednesday.
Although Republican leaders have called on party members to coalesce around the proposed healthcare reform law, the facade continues to show cracks. The legislation has already been slammed by the Freedom Caucus, an ultra-conservative group of nearly 40 House members who have taken issue with the bill's tax credit provision and have the votes to take down the bill.
Sen. Mike Lee of Utah blasted the bill as "a step in the wrong direction" during a news conference with Sen. Rand Paul of Kentucky and House Freedom Caucus members.
Republicans have a clear majority in the House, and the American Health Care Act may still pass even with some conservative holdouts and no Democrat support. But the struggles don't end there. Four GOP senators have already vowed to vote against the proposed law unless it is updated to address their Medicaid expansion concerns.
Sens. Rob Portman (R-Ohio,) Shelley Moore Capito (R-W.Va.), Cory Gardner (R-Colo.) and Lisa Murkowski (R-Alaska) told Senate Majority Leader Mitch McConnell (R-Ky.) that the proposal must extend the transition period for eliminating Medicaid expansion in order to receive their support. The four senators said that provision could leave the most vulnerable populations in their states without coverage. The current proposal in the House bill cuts off Medicaid expansion on Dec. 31, 2019.
Federal lawmakers may also feel pressure from conservative thinktanks and lobbying groups. Freedom Partners and Americans for Prosperity in a joint letter on Tuesday said the proposed law creates a new entitlement in the form of tax credit subsidies, turning the American Health Care Act essentially into Obamacare 2.0.
Right before the bill was released Monday, Sen. Marco Rubio (R-Fla.) told hospitals attending a health policy conference hosted by the Federation of American Hospitals that Republicans need to develop some policy option to help low-income individuals buy insurance. If they don't fund tax credits, the federal government will be on the hook to help cover the inevitable increase in uncompensated-care costs incurred by hospitals.
“One way or the other, we're going to pay for people's healthcare,” Rubio said.
It's unclear how the impasse will end. The American Health Care Act was endorsed by President Donald Trump via tweet, which could embolden Republican lawmakers to move forward with the bill mostly as is despite the pushback from their more conservative colleagues.
The Associated Press contributed to this report.