WASHINGTON (AP) — Republican leaders on Thursday described plans for replacing President Barack Obama's health care law to House GOP lawmakers, promoting a conservative approach dominated by tax breaks and a transition away from today's Medicaid program.
With their drive to reshape the nation's health care system off to a sputtering start, House Speaker Paul Ryan, R-Wis., and other leaders were describing detailed options and gauging the rank-and-file's receptiveness in a private meeting. Lawmakers also heard from Health and Human Services Secretary Tom Price, a former GOP congressman from Georgia.
The briefing came hours before a weeklong recess that will send Congress home to energized voters, mostly Democrats, who have recently crammed town hall meetings to complain about GOP efforts to repeal Obama's law. Lawmakers are eager to have something to show constituents.
"It's important for people to know we're working hard on these things, paying attention to substance," said Rep. Patrick Meehan, R-Pa., as he entered the meeting.
Rep. Greg Walden, R-Ore., chairman of the House Energy and Commerce Committee, said that by the end of March, his panel would start writing its part of a measure voiding much of Obama's law and substituting GOP programs. That's the most recent of several self-imposed deadlines that President Donald Trump and GOP leaders have set, but until now failed to meet, for reconfiguring the nation's health care system.
With Senate Republicans straining to coalesce around plans, Price met privately with GOP senators Wednesday, but participants said no specifics were discussed. Sen. Roger Wicker, R-Miss., said lawmakers and the White House are trying to decide who should release a plan to replace Obama's law first — the White House or Congress.
Asked to characterize those discussions, Wicker said: "You go first. No, you go first."
Thursday's House GOP meeting followed moves the day before by the Trump administration aimed at curbing Obama's law. These included making it harder for people to sign up for coverage outside of open enrollment periods and eased IRS enforcement of fines for people who don't buy insurance.
Lawmakers, aides and lobbyists who described House leaders' plans said they strongly resembled a broad outline that Ryan released last summer as a campaign document for Republican candidates to tout to voters. Most spoke on condition of anonymity because the proposals hadn't been released publicly.
In a significant departure from Ryan's summertime proposal, the options being discussed Thursday would not address Medicare, which helps pay for guaranteed health care for the elderly. Ryan has backed reshaping it into a voucher-like program that people could use to buy coverage, but Trump has said he doesn't want to revamp Medicare.
Under the ideas being talked about, the tax penalties that Obama's law imposed on people who don't buy insurance would be killed. Also eliminated would be the subsidies the government provides most people who buy coverage on the online marketplaces the statute established.
Instead, tax-favored health savings accounts would be expanded and refundable tax credits, paid in advance, would be available to millions of Americans. With refundable credits, even people with low or no income would receive checks from the IRS.
On one of the most contentious issues, Republicans would gradually change Medicaid, which helps poor and disabled people afford health care. While it now guarantees coverage for everyone who qualifies, the options being discussed include giving money to the states generally based on the number of Medicaid beneficiaries with adjustments for the type of care they need, and states would have more power to decide who qualifies for coverage.
Republicans would provide extra money to both the 31 states that expanded Medicaid coverage under Obama's law and the 19 others — mostly dominated by the GOP — that refused to do so. That disbursement of funds has caused major rifts between GOP-led states that increased their Medicaid coverage and don't want to lose that money, and states that didn't expand but want extra funds now.
The GOP plans also include federal contributions to states for high risk pools, where people with illnesses that are expensive to cover could purchase policies.
And because of many Republicans' opposition to abortion, the retrofitted medical system would block Planned Parenthood from receiving federal payments, which comprise nearly half its annual $1.1 billion budget.
Democrats defending Obama's law oppose all of the GOP ideas, saying they'd leave many people unable to afford health coverage.
Associated Press reporter Stephen Ohlemacher contributed to this report.