Top House Republicans unveiled a rough sketch of a massive health care overhaul to rank-and-file lawmakers Thursday, but a lack of detail, cost estimates and GOP unity left unresolved the problem that's plagued them for years: What's the party's plan and can Congress pass it?
At a closed-door meeting in the Capitol basement, House Speaker Paul Ryan, R-Wis., and other party leaders described a broad vision for voiding much of President Barack Obama's 2010 statute and replacing it with conservative policies. It features a revamped Medicaid program for the poor, tax breaks to help people pay doctors' bills and federally subsidized state pools to assist those with costly medical conditions in buying insurance.
Lawmakers called the ideas options, and many were controversial. One being pushed by Ryan and other leaders would replace the tax increases in Obama's law with new levies on the value of some employer-provided health plans - a political no-fly zone for Republicans averse to tax boosts.
"You have to legislate with a sense of political reality," said Rep. Tom Cole, R-Okla., who said backing that proposal "would set up an ad against you from multiple directions" during upcoming elections.
Senate Republicans have criticized a House GOP plan to change how corporations are taxed. Trump has said he will release his own proposal in the coming weeks, but Democrats are criticize the Republican majority for not yet having a specific plan,
"At some point we need to move from imaginary made-up plans to things that you can read on paper," said Sen. Mark Warner, D-Va.
The health care outline was aimed at giving Republicans something to exhibit during next week's congressional recess, at a time of boisterous town hall meetings packed with supporters of Obama's law. Ryan told reporters that Republicans would introduce legislation voiding and replacing Obama's statute after Congress returns in late February, but offered no specifics.
Many Republicans took an upbeat tone after Thursday's meeting, with Rep. Peter King, R-N.Y., saying, "We're only 27 days into the new administration, so we have time."
"We're not going to get out of this overnight," added Rep. Bill Huizenga, R-Mich.
The uncertainty about the future of Obamacare could cause insurers to quote prices and plans for 2018 by the required May date. On Monday, Humana said it is dropping out of the health exchanges next year in 11 states, including Tennessee where Humana is the only insurer with individual Obamacare plans in 16 counties.
Chris Coleman, staff attorney for the Tennessee Justice Center and a supporter of Obamacare, said other insurers may follow Humana's lead in dropping exchange plans next year amid the uncertainty of what changes may be ahead.
"I'm afraid we may see other insurers drop or limit their coverage in this uncertain market," said Coleman, who said repealing the Affordable Care Act without an adequate replacement threatens the health of 562,000 Tennesseans who rely upon some part of Obamacare.
The Chattanooga-based BlueCross BlueShield of Tennessee, faced with nearly $500 million in losses in the first three years of the health exchange plans under Obamacare, pulled out of Tennessee's three biggest markets this year with its individual plans even after gaining state approval for an average 62 percent rate increase. Roy Vaughn, senior vice president and chief communications officer at BlueCross, said the insurer "has tried to make the ACA Marketplace model work for Tennessee," despite unexpected cuts in some federal reimbursements and a sicker-than-expected population that has signed up for Obamacare program.
"We're doing our best to work through the uncertainties at the federal level and still considering whether we will continue to offer coverage in the same regions for 2018," Vaughn said Wednesday. "At this point, we do not anticipate a scenario where we would expand into the Memphis, Nashville or Knoxville regions (where 131,000 people were previously insured by BlueCross plans)."
U.S. Sen. Lamar Alexander said without changes, many of the 18 million Americans in the individual insurance market "may have zero choices for insurance next year, so having an Obamacare subsidy could soon be like having a bus ticket in a town where no buses run."
Alexander has urged his Republican colleagues to develop a suitable replacement for Obamacare before the health are plan is totally repealed. Lawmakers said they were awaiting official cost estimates from the nonpartisan Congressional Budget Office, which could ignite other battles if the price tag is disconcertingly high.
Obama's law levied $1.1 trillion in taxes over a decade to finance its expanded coverage to millions. GOP leaders said some or all of those taxes could be repealed, with the revenue replaced by a new tax on health care that employees receive at work.
Two people familiar with the proposal said individuals would pay taxes on the value of such coverage above $12,000, and above $30,000 for families. Republicans would not confirm those amounts, though House Ways and Means Committee Chairman Kevin Brady, R-Texas, told reporters "the vast, vast majority of Americans" would be unaffected.
According to documents distributed to members and obtained by The Associated Press, the expansion of Medicaid to millions of additional poorer people - almost entirely financed by federal taxpayers - would be phased out. In a compromise aimed at resolving a bitter dispute, extra Medicaid money would flow to the 31 states that accepted that expansion and the 19 that didn't, though it would end "after a certain date" left unspecified.
After that, states would get far more discretion to decide who would be covered by Medicaid. They'd also decide whether to receive federal Medicaid funds based on the fluctuating numbers of the program's beneficiaries or a set annual amount.
The tax penalties Obama's law levies on people who don't buy insurance would be abolished, as would federal subsidies for most people buying coverage on the online exchanges the statute established. They would be replaced by tax credits for people who don't have job- or government-provided health coverage and tax-advantaged health savings accounts. Republicans said decisions on amounts have not been made.