ACA Repeal Legislation Stumbles but Advances; Trump Urges Adding Work Requirements to Medicaid

The Congressional Budget Office (CBO), an independent, non-partisan agency, reported on March 13 that the House Republican bill to repeal the Affordable Care Act (ACA) would reduce access to healthcare coverage for 24 million people over ten years. Republican leaders from the White House and Congress dismissed the CBO’s findings and defended their proposal, while signaling a willingness to make changes to the bill to address the concerns of their Republican colleagues. In an effort to assuage conservatives, President Trump recommended adding provisions to allow states to impose work requirements, premiums, and emergency-room copayments within Medicaid.

The House Budget Committee agreed by a 19-17 mostly party-line vote on March 16 to advance the legislation to the full House, which is expected to vote on it this week. Three Republicans – Senators Mark Sanford (SC), Dave Brat (VA) and Gary Palmer (AL) – voted against the motion.

Several Republican senators warned against repealing the ACA without a fully developed plan for a replacement. Others expressed concerns that the House plan would harm states that had expanded access to Medicaid, which provides health insurance to more than 70 million low income people, and would result in steep cost increases. The CBO reported that the repeal bill would cut Medicaid spending by a quarter over the next 10 years, a reduction of $880 billion that would lead to a 17% reduction in enrollees and/or require states to shoulder more of the cost burden. More conservative House Republicans argued that the repeal bill does not go far enough. They prefer ending the ACA’s Medicaid expansion sooner and reducing tax credits that would be provided in the House bill to help people pay for private health insurance.

To garner more support in the House, President Trump has asked Republican leaders to add provisions to the healthcare repeal bill to allow states to restrict access to Medicaid by imposing work requirements, premiums, emergency-room copayments, and other changes that would make it more difficult for low income people to access the assistance.

Senate Democrats, led by Senator Chuck Schumer (D-NY), continued to oppose all efforts to repeal and replace the ACA. "More and more Republicans don't like [the House bill], and Democrats are totally united against it,” Mr. Schumer said.  “Democrats are going to stand strong, stay united, and fight tooth and nail against Trumpcare until our Republican friends drop their repeal effort for good.”