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Republicans plan key changes on subsidies, Medicaid for ACA replacement

March 6, 2017 at 6:50 PM EDT
Republican lawmakers released their bill to repeal and replace the Affordable Care Act on Monday evening. Proposed changes include ending direct government subsidies in favor of tax credits, ending penalties of the individual mandate and phasing out the expansion of Medicaid in 2020. Lisa Desjardins talks with John Yang from Capitol Hill.
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JOHN YANG: Moments ago, House Republicans released their bill to meet a key Trump campaign promise, to repeal and replace the Affordable Care Act, often called Obamacare.

Some of the key changes include ending direct government subsidies for low- and middle-income Americans to buy coverage. Instead, there will be refundable tax credits to do that. Ending penalties of the individual mandate, and a phase-out of the expansion of Medicaid in 2020, but coverage would continue for a while for those already covered.

Lisa Desjardins just attended a briefing in the House Ways and Means Committee. She joins me now from Capitol Hill.

Lisa, some of these proposals are not popular among conservative Republicans, are they?

LISA DESJARDINS: That’s right, in particular the tax credits. Some Republicans say that’s just another way to giving subsidies to Americans for their health care.

But the tax credits are a very key component here. The way they would work, John, is any individual who makes $75,000 or less would get some amount of money to help them buy health care, but as a tax credit. It would depend on how old you. The largest tax credit would go to those Americans over 60. They would get $4,000 to help to go to the health care.

Of course, on the other side, Democrats say this doesn’t do enough to help those populations that can’t afford health care get where they need to be.

JOHN YANG: And the governors, even some Republican governors, who have used the Obamacare to expand Medicaid, are they going to be happy with the phase-out of that money?

LISA DESJARDINS: For a couple of years, they will be happy. And then they will have some problems in their states potentially, depending on how this works.

If you were on the Medicaid expansion, those are basically what they call able-bodied workers, people who are under the poverty threshold, about 138 percent of poverty, people who really can’t afford health care essentially, but don’t fall into other categories of Medicaid.

Right now, you are able to receive health care through the Affordable Care Act. But you will be able to receive that for the rest of your life if you are enrolled now. You will be grandfathered into this system.

However, after 2020, there will be no people in that category allowed to join. So, we’re talking basically working-age adults who do not earn much money. You can enroll now up until 2020. You will not be able to enroll in Medicaid after that.

JOHN YANG: All this, of course, is if it passes and if it passes in the current form.

Sean Spicer at the White House said the target date for signing this bill would be the Easter recess. How likely is that? How realistic is that, Lisa?

LISA DESJARDINS: Well, we can just look back at the Affordable Care Act itself.

It similarly had an early summer, I believe, goal date of being passed. When was it actually signed into law? The next year, 2020 (sic). So, that’s an incredibly ambitious goal, John. The next couple of days will tell us a lot about whether that is even doable. We expect committees to start poring over the details.

And, as you said, John, there are disagreements not just from Democrats, but from Republicans about the details of this plan.

JOHN YANG: Lisa Desjardins, who is going to be busy following all those details as they make their way through Capitol Hill, Lisa, thanks a lot.

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