GOP's ObamaCare talking points leave many questions unanswered

GOP's ObamaCare talking points leave many questions unanswered
© Getty

(This story originally appeared in The Hill Extra.)

House Republicans are heading home for a one-week recess with a new outline on their plans for replacing and repealing ObamaCare, but the document leaves many key questions unanswered.

GOP leadership issued the 17-page memo on Thursday, with a mix of traditional healthcare talking points and elements from previous Republican health plans.

The memo was shared with lawmakers after a closed-door briefing, and is aimed at helping members who have faced some tough questions about their ObamaCare plans in recent weeks.

For now, it appears Republican lawmakers are still in the education phase.

"There was no attempt to come to a consensus today; today was more informational," Rep. Morgan GriffithHoward (Morgan) Morgan GriffithOvernight Health Care: Big Pharma looks to stem losses after trade deal defeat | House panel to examine federal marijuana policies | House GOP reopens investigation into opioid manufacturers House GOP reopens investigation into opioid manufacturers over role in crisis The 27 Republicans who voted with Democrats to block Trump from taking military action against Iran MORE (R-Va.), who sits on the Energy and Commerce Committee, said. 


House Energy and Commerce Chairman Greg Walden (R-Ore.) and Ways and Means Chairman Kevin BradyKevin Patrick BradyConservative groups aim to sink bipartisan fix to 'surprise' medical bills Trump economic aide says new tax proposal could be unveiled this summer Hoyer: Democratic chairmen trying to bridge divide on surprise medical bills MORE (R-Texas) outlined ObamaCare replacement items leadership wants to include in its bill gutting major provisions of the Affordable Care Act.  

These include how to reform Medicaid and deal with the states that chose to expand the program; tax credits to help Americans pay for insurance; high-risk pools; and health-savings accounts.  

“I think the membership is going to have to have time to digest a lot of this,” Griffith said.

To be clear, legislative text hasn’t yet been released, so the details are limited. Speaker Paul RyanPaul Davis RyanThe Hill's Morning Report — Dems detail case to remove Trump for abuse of power Social security emerges as latest flash point in Biden-Sanders tussle Hill.TV's Saagar Enjeti rips Sanders for 'inability to actually fight with bad actors' in party MORE (R-Wis.) said he’s waiting on scores from the Congressional Budget Office before unveiling a bill.

Ryan has previously said he plans to repeal and replace parts of ObamaCare by spring. 

But several main questions — and potential sticking points — remain.


1. Tax credits vs. deductions.

The new outline calls for an advanceable, refundable tax credit for those who don’t have insurance through an employer or other government program. 

Brady told reporters that tax credits cover “more people because it applies to those who don't have a tax liability. And it’s advanceable, so it's available today. A deduction is available a year or 16 months later whenever you do your taxes. So the thinking is to have that help immediately to allow an individual to have it sent to that insurance company.”

But other lawmakers, such as Rep. Phil Roe (R-Tenn.), say they prefer a deduction.

“I like the deduction because I think it encourages you to look for the cheapest plan,” Roe, co-chair of the GOP Doctors Caucus, said. He added he understands the disadvantage of the deduction is Americans would have to finance their plan for a year or more.

Policy analysts see a big difference between the two. That’s because the deduction doesn’t necessarily help those in the lower tax brackets who don’t pay federal income taxes, and the new outline echoes that sentiment.

Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus, said he prefers deductions, but he doesn't draw a hard line between the two — unless it’s advanceable and refundable tax credits. He argued the latter is prone to fraud.


2. Helping governors who did — and didn’t — expand Medicaid.

Determining how to tackle Medicaid is one of the prickliest debates the GOP will likely encounter. GOP governors who originally bucked the party line and expanded the program want to ensure their constituents don’t lose coverage. Those who didn’t expand don’t want to get financially dinged for it.

“How we deal with that tricky little thing is going to be hard,” Roe told The Hill Extra. “I’m not saying I‘m pessimistic, I’m just saying it’s going to be hard.”

According to a source in the room, members are aware of the differences between expansion and nonexpansion states, and that conversations on how to address that will continue.

The updated GOP proposal would repeal Medicaid expansion for able-bodied adults, but states would continue to receive the enhanced federal match rate for a limited time. Later, states that choose to keep their expansion programs would be reverted back to their pre-expansion match rates. The proposal says nonexpansion states could receive additional, temporary resources for safety net providers.

The outline also allows states to choose between block grants and per capita caps.

One of the concerns is that the proposal might be getting too expensive, House Republican Study Committee Chairman Mark Walker (R-S.C.) said.

“My concern is with this Medicaid is that it gets off the chain,” he said. “We’re waiting for the CBO numbers, that’s one of the two major sticking points as far as everybody signing off on this particular plan.”


3. Capping the employer tax exclusion.

One thing the outline was noticeably missing: money.

“That’s going to be the $94 question, whether it’s on tax reform or whether it’s on healthcare reform,” said Rep. Mark Sanford (R-S.C.), who is working on a companion bill to Sen. Rand PaulRandal (Rand) Howard PaulLindsey Graham will oppose subpoena of Hunter Biden Marsha Blackburn shares what book she's reading during Trump Senate trial Sekulow indicates Trump should not attend impeachment trial MORE's (R-Ky.) ObamaCare replacement legislation. 

The Better Way proposal included capping the tax exclusion for employer-sponsored health coverage, and GOP lawmakers discussed the concept during their closed-door meeting Thursday.

“It is a tough approach,” Rep. Bill FloresWilliam (Bill) Hose FloresDemocrats push to end confidentiality for oil companies that don't add ethanol The Hill's Campaign Report: Warren, Sanders overtake Biden in third-quarter fundraising The Hill's Morning Report — Trump broadens call for Biden probes MORE (R-Texas) said, “but if you really want to fix healthcare and make healthcare available for all, then you've got to look at the imbalance between the way employers can buy healthcare coverage and the way families buy healthcare coverage. Somewhere those disparate treatments need to be broken down and equalized.”

Senate health committee Chairman Lamar AlexanderAndrew (Lamar) Lamar AlexanderBolton upends Trump impeachment trial  McConnell urges GOP senators to keep powder dry on witness question Murkowski 'curious' to hear what Bolton has to say MORE (R-Tenn.) said the concept was on the table earlier this week at the National Association of Health Underwriters conference.

But Republicans aren’t 100 percent sure they’re going to go down that path, Brady said. Either way, they’ll have to find a way to pay for their proposals.

Casey Harper contributed to this report. 


See more exclusive content on policy and regulatory news on our subscription-only service here.