Capitol Hill lawmakers from both political parties on March 2 intensified their search for a Republican plan to replace the Affordable Care Act, but House Ways and Means Committee Chair Kevin Brady, R-Texas, said revenue estimates have not been completed on a final bill.
Ahead of a possible markup of healthcare legislation by the House Energy and Commerce Committee on March 8, several House Democrats and one Senate Republican criticized the lack of access to the House plan, which is currently being scored by the Congressional Budget Office.
House Minority Whip Steny H. Hoyer, D-Md., Energy and Commerce member Paul Tonko, D-N.Y., and Sen. Rand Paul, R-Ky., went to a room on the first floor of the Capitol where the committee was reportedly allowing lawmakers to view the latest version of the GOP's replacement plan. Finding no legislation, the lawmakers held impromptu press conferences calling for the House Republican leadership to make the documents public.
In a separate press briefing, Brady said he continues to work with the CBO on details of the legislation while fine-tuning proposals with fellow GOP lawmakers. Brady said no date for a Ways and Means markup has been scheduled yet, pending finalization of the measure's specifics. The committee must provide notice 72 hours before holding a markup.
Asked if healthcare tax credits in the ACA replacement plan would be based on income, Brady said he and members of the Republican conference have identified two or three options for targeting credits to the correct beneficiaries.
Paul used his press conference to compare the bill -- which could be marked up in committee during the week of March 6 -- to his own legislative proposal.
"What many conservatives object to is we don't want an Obamacare Lite. Keeping the 'Cadillac' tax is unacceptable. Having a refundable tax credit is the same as subsidies," Paul said. "And then also keeping the individual mandate, where you don't pay a penalty to the government, but you pay a penalty to the insurance company. That's all unacceptable, but what is completely unacceptable is not being able to review the bill."
But Brady said he and Energy and Commerce Chair Greg Walden, R-Ore., met on March 1 with Paul and other Senate Republicans, many of whom offered suggestions for improving the ACA replacement plan. "Clearly, every senator in that room knows exactly the direction we're going as well as some of the improvements that have yet to be made," Brady told reporters. "We don't have a bill. We're continuing to work with CBO and our members on the final policy decisions."
Paul called again for Congress to take up last year's reconciliation bill that was vetoed by President Obama, suggesting that House Republicans "don't want the criticism. I think if you believe what's been reported, they want to dare conservatives to vote 'no.' I'm a conservative that stands by what I say, when I say let's repeal the whole thing."
Paul suggested that his replacement bill, the Obamacare Replacement Act (S. 222), would implement market reforms and take a different approach than what House Republicans are planning.
"Let's try market reforms instead of another government program, with a new government subsidy program and a new mandate. That sounds like Obamacare under a different name. These are Democratic ideas in Republican clothing. Let's just vote for repeal. That's all I'm asking," Paul said.
Senate Finance Committee member John Cornyn, R-Texas, said he had an "encouraging" healthcare reform discussion with Brady on March 1, adding that he was optimistic that a repeal-and-replace bill with a provision to cap the employer-sponsored insurance exclusion could pass the Senate.
"I think we're going to have to come up with some means to pay for the tax credits the president mentioned, so I think, to my mind, that's a reasonable approach," Cornyn told reporters. "I think what's going to happen is the House is going to pass a bill, and it's going to come to the Senate, and it will be a binary choice: either we keep our promise or break our promise."
Cornyn said that "everybody will get to read the bill at some point, but the House hasn't passed it yet. As soon as they pass it, sure. Everybody will have access to it."
But Hoyer, speaking during his weekly floor colloquy with House Majority Leader Kevin McCarthy, R-Calif., said Republicans were not operating transparently or under regular order for processing legislation. Hoyer failed to learn where Republicans were holding copies of their ACA legislation ahead of possible committee markups.
Democrats Want Access Before Markup
House Ways and Means Committee ranking minority member Richard E. Neal, D-Mass., at a March 2 press conference said the transparent process Democrats took to debate the ACA is being abandoned now by Republicans working on their healthcare legislation.
Neal, joined by several committee Democrats, offered remarks focused on the broad effects that repealing the 2010 healthcare law could have on those who obtained coverage under the ACA, expressing that their constituents living in uncertainty deserve to see the legislation Republicans have kept "in hiding."
Committee member Joseph Crowley, D-N.Y., told reporters "it's a bit of a joke" that Republicans have yet to release legislative language to repeal and replace the ACA, adding that he and several other Republican and Democratic lawmakers have been scrounging the Capitol campus looking for the bill's text.
Neal plans to offer amendments to controversial provisions during an expected full committee markup, though he acknowledged they may have very little time to review the legislation, making it difficult to prepare beforehand.
Ways and Means Tax Policy Subcommittee ranking minority member Lloyd Doggett, D-Texas, told Tax Analysts that he is preparing amendments based on the leaked House Republican replacement plan in anticipation that those tax provisions, like capping the employer-sponsored insurance exclusion, are retained. However, it remains unclear if Republicans have since changed the bill dated February 10.
"There are major changes here that will impose taxes on middle-class families," said Doggett, adding that lawmakers should have cost estimates from the Joint Committee on Taxation and the CBO. "It's unprecedented almost to have committee action on a bill of this sort without that kind of fiscal responsibility," he said.
Doggett suggested that Republicans be held to the set of standards advocated by President Trump during his February 28 joint address to Congress in which he called for expanded healthcare coverage and lower premium costs and better quality of care.
Doggett said a letter to Brady from House Ways and Means Democrats request that Trump send a member of his administration to attend a hearing on the GOP healthcare repeal legislation to ensure that the bill will "match up to his standards."
Fellow committee Democrat Earl Blumenauer of Oregon said that from the day the ACA was signed into law, Democrats have been open to making improvements to the law if "we find areas of agreement" within the framework of the committee. "All of us here have been involved with bipartisan healthcare legislation, but the notion that we are excluded fundamentally, from something that's going to be floated out illustrates not only have they not been serious, [but] how do we work with people who are indicating they don't want to work with us?"
ACA Repeal Moving Deliberately, Republicans Say
Energy and Commerce committee member Chris Collins, R-N.Y., slightly walked back his remarks from the day before, when he said committee markups were imminent.
Collins told reporters that there will be "plenty of time to modify the bill," and for Democrats to see the bill during the process, but that Republicans would move ahead with markups even without revenue estimates from the CBO or JCT. He added that "this is being done with the Parliamentarian in the Senate to make sure we do meet the Byrd rule" on blocking bills deemed extraneous to reconciliation, he said.
Ways and Means member David Schweikert, R-Ariz., said that while many bipartisan lawmakers and stakeholders have concerns with the Republican plan to cap the exclusion for employer-provided health insurance, the revenues it would generate would "become one of the biggest parts of our tax code."
Schweikert added that the decision to cap employer-sponsored coverage also tries to account for a new-generation workforce in which individuals may work for several different employers over a short period of time. "It's not the 1950s anymore, where you go to work for somebody and you're there forever. But that's actually how our model is; it's trapped ambition. So it's not just thinking about what's the tax rationale, but also what's the societal rationale."
At an ERISA Industry Committee event in Washington, House Ways and Means Committee member Mike Kelly, R-Pa., told Tax Analysts he has not seen the repeal-and-replace legislation, adding that he didn't know when the committee would hold a markup. "This is really complicated stuff . . . I'm not saying [the committee] hasn't done the background, but there's a lot of things that just aren't complete yet," he said.
Kelly, who introduced a bill to repeal the Cadillac tax on high-cost employer-sponsored health plans, said that he does not know yet whether he will offer amendments to the legislation when Ways and Means holds a markup.
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