Tonight, I’ll be welcoming President Donald Trump to Nashville as he talks with Tennesseans on the serious issues facing this nation. We know that everyone is concerned about national security, jobs, the economy and of course, healthcare. We expect the President to touch base on each of these issues tonight.
Over the past three years, I have heard from countless constituents how they and their families have been negatively affected by the Affordable Care Act and last week, Congress took its first step in repealing this flawed law. You might have watched some of our marathon committee markup on C-SPAN or heard the news reports of how we worked for over twenty-seven hours on making the process and policy more reflective for the needs of the American people. Believe me, we have heard your stories of higher premiums, narrowed networks, and denial of services for insurance that is too expensive to even utilize. Based on your concerns, we need to repeal the Affordable Care Act and put the needed reforms in place that have been neglected for over a decade.
With that, I would like to continue the discussion with you in order to expand upon the process and substance of the bill. Today, I’d like to walk you through the process of budget reconciliation, what the American Health Care Act repeals, replaces, and reforms; and the concerns we are still working through in order to address the American people’s health care needs.
Last Wednesday, the Committee on Energy and Commerce held a public forum called a legislative markup on the American Health Care Act (AHCA). This bill, The AHCA, is made up of two separate sections with jurisdiction in my committee, the Committee on Energy and Commerce and dual jurisdiction within the Committee on Ways and Means. The first section of the bill, with oversight of the Committee on Energy and Commerce, addresses the Medicaid and Affordable Care Act provisions of the law. The second section of the bill, which funnels through the Committee on Ways and Means, addresses the tax provisions of the law. The Energy and Commerce’s jurisdiction focuses on the provisions of Medicaid and the non-tax provisions of the Affordable Care Act. The Committee on Ways and Means Committee’s jurisdiction covers the tax related provisions of the law.
With that, the Subcommittee on Health spent over twenty-seven hours discussing our portions of this bill with our Republican and Democrat colleagues. Throughout the night, over 70 amendments were offered and filed by members of the committee. Members and staff spent countless hours reviewing every amendment until the final gavel was offered on Thursday afternoon. Both committees spent multiple hours offering healthy debate and we believe this measure was not rushed through because both parties were able to voice concerns, offer solutions – and our committee spent almost thirty hours debating each idea prior to members voting to advance the bill in Congress.
Here is what the AHCA does:
- The Individual and Employer Mandates
- Obamacare subsidies beginning in 2020
- Sunsets Medicaid expansion beginning in 2020
- Postpones the “Cadillac Tax” on expensive employer-sponsored plans until 2025
- Eliminates all of Obamacare’s taxes, effective after 2017
- Limits payments to insurers for cost-sharing reductions by 2020
Replaces – Ways and Means Committee:
Advanced and refundable tax credits based on one's age
- Under 30: $2,000
- Between 30 and 39: $2,500
- Between 40 and 49: $3,000
- Between 50 and 59: $3,500
- Over 60: $4,000
The credits are available in full to individuals making up to $75,000 and families making up to $150,000. For every $1,000 in income higher than those thresholds, the credits decrease by $100
- Expanded health savings accounts
- AHCA increases maximum contributions to health savings accounts, or medical savings accounts, to $6,550 for individuals and $13,100 for families beginning in 2018
- Protections for consumers with pre-existing conditions
- Continuous coverage requirement for our most vulnerable populations
- Flexibility on age-based ratios – allowing better consumer choice and opening narrow networks
- Per-capita caps for Medicaid, based on each state’s number of enrollees, beginning in 2020
- Funds for states to set up high-risk pools, reduce out-of-pocket costs, or stabilize health insurance markets
- One-year freeze on government funding to elective-abortion providers
- Letting adults remain on parents’ plans until age 26
- Tax exclusion for employer-sponsored coverage
The budget reconciliation process is an optional procedure under the Congressional Budget Act of 1974 that operates as an adjunct to the annual budget resolution process. The chief purpose of the reconciliation process is to enhance Congress's ability to change current law in order to bring revenue and spending levels into conformity with the policies of the budget resolution. Accordingly, reconciliation may be the most potent budget enforcement tool available to Congress for a large portion of the budget.
Reconciliation is a two-stage process in which reconciliation instructions are included in the budget resolution directing the appropriate committees to develop legislation achieving the desired budgetary outcomes, and the resultant legislation (usually incorporated into an omnibus bill) is considered under expedited procedures in the House and Senate.
Within Medicaid expansion, Congressman Barton and I are working with our committee to address the Obamacare Medicaid expansion portion that is still set in place for three years after the policy is enacted. We are seeking to offer solutions to alter the worsening of the federal and state budgets by not incentivizing states to maintain expansion or to initiate new expansions and leaving the federal government picking up the majority of the bill.
For the tax credits portion of the bill, we want to be surefor future Congresses to come that we remain financially responsible and reduce the enhanced payments to states for expansion. While these creditsallow more choices for individuals, and is more patient-centered, it is fundamentally grounded on the idea that the federal government should fund insurance purchases. We want to ensure that we are not creating a large entitlement that the federal government simply cannot afford.
Most importantly, we want to ensure proper protection for the sanctity of life. While the current policy seeks to address pro-life safeguards on credit use, the language is ambiguous and it is unclear if such protections can survive Senate Byrd requirements as drafted.
While there is still much work to do on health reform – this bill is not the final step. This measure is only the first step for beginning the discussion of federal health reform. For over six years, I have listened to my constituents and their requests to repeal this law and Congress took the initial step to repeal and replacing the Affordable Care Act.This battle is far from over. We have more work to accomplish for the betterment of the American people.