WASHINGTON — House Republicans, responding to criticism that repealing the Affordable Care Act would leave millions without health insurance, said on Thursday that their goal in replacing President Obama’s
health law was to guarantee “universal access” to health care and
coverage, not necessarily to ensure that everyone actually has
insurance.
In
defending the Affordable Care Act, the Obama administration,
congressional Democrats and advocacy groups have focused on the 20
million people covered by the law, which has pushed the percentage of
Americans without health insurance to record lows. The American Medical
Association recently said that “any new reform proposal should not cause
individuals currently covered to become uninsured.”
But House Republicans, preparing for a rapid legislative strike on the law next month, emphasize a different measure of success.
“Our
goal here is to make sure that everybody can buy coverage or find
coverage if they choose to,” a House leadership aide told journalists on
the condition of anonymity at a health care briefing organized by
Republican leaders.
Republicans
have an “ironclad commitment” to repeal the law, the aide said, as
lawmakers moved to discredit predictions that many people would lose
coverage.
“There’s
a lot of scare tactics out there on this,” said Representative Kevin
Brady, Republican of Texas and chairman of the Ways and Means Committee.
“We can reassure the American public that the plan they are in right
now, the Obamacare plans, will not end on Jan. 20,” the day Donald J. Trump will be inaugurated.
The
suggestion that 20 million people will lose coverage is a “big lie,”
Mr. Brady said, after meeting here with Republican members of his
committee.
“Republicans,”
he said, “will provide an adequate transition period to give people
peace of mind that they will have those options available to them as we
work through this solution.”
Republicans
have not settled on the details or the timing of their replacement
plan. The House speaker, Paul D. Ryan of Wisconsin, portrays repeal of
the law not as an ideological crusade, but as a form of urgently needed
relief.
“Insurance markets are collapsing,” Mr. Ryan said this week. “Premiums are soaring. Patients’ choices are dwindling.”
The
House leadership aide said that repealing major provisions of the law
was a priority for the first 100 days of the Trump administration. But,
he said, the date that those provisions would actually disappear would
be delayed, allowing a transition period as short as two years or as
long as three or four years. During that time, Republicans plan to pass
one or more replacement bills.
By
giving people the choice to buy insurance, Republicans could end up
dangerously skewing the health insurance market, Obama administration
officials and insurance executives say. Sick people are more likely to
sign up, they say, and there may not be enough healthy people paying
premiums to cover the costs for those who are less healthy.
Under
the Affordable Care Act, people who go without insurance are subject to
tax penalties. The Internal Revenue Service says that more than eight
million tax returns included penalty payments for people who went
without coverage in 2014.
The House leadership aide said that lowering the cost of insurance was a much better way to encourage people to opt in.
“We
would like to get to a point where we have what we call universal
access, where everybody is able to access coverage to some degree or
another,” the aide said. “Over the past six years, if you look at the
experience we’ve had with the A.C.A. rollout, chasing coverage doesn’t
necessarily yield great outcomes. You can have people going into an
exchange, finding out that their pediatrician is no longer available to
them.”
The
aide said House Republicans had not decided on the future of
cost-sharing subsidies that are paid by the federal government to
insurance companies. Such subsidies are intended to reduce out-of-pocket
costs for millions of low-income people buying insurance under the
Affordable Care Act.
A
federal district judge, responding to a lawsuit filed by the House,
ruled in May that the Obama administration had paid billions of dollars
to insurers since January 2014 even though Congress had not appropriated
money for such “cost-sharing reductions,” and that the payments
therefore violated the Constitution. Without that money, estimated at
$130 billion over 10 years, insurers would increase premiums or pull out
of the insurance exchanges, creating chaos for consumers, some health
policy experts say.
But
now that the House leadership has won a legal victory, Republicans have
not decided how to proceed. The aide declined on Thursday to say if
Republicans would seek an immediate halt to the cost-sharing subsidy
payments. He did not rule out the possibility that a
Republican-controlled Congress might keep the money flowing for a
transition period, to stabilize the market while Republicans develop
alternatives to the health law.
“It’s an open question,” he said.
Republicans said they were more interested in vindicating Congress’s constitutional power of the purse.
In
any event, the House leadership aide said, Republicans do not intend to
pull the rug out from people who have gained insurance under the
Affordable Care Act.
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