By Yasmeen Abutaleb and Richard Cowan
WASHINGTON (Reuters) – Congressional Republicans reformulated their Obamacare replacement bill on Monday in hopes of satisfying critics as US President Donald Trump prepared to promote his first major legislative initiative on Capitol Hill. .
In a sign of growing concern among Republicans about the bill’s future, Trump will speak with party lawmakers in Congress Tuesday about the health care review, two Republican House aides said.
The Republican leadership proposed a series of amendments that marked major legislative changes, but it was not immediately clear whether they would help win more Republican support amid strong opposition from Democrats.
A leading conservative voice in the House, Representative Jim Jordan of Ohio, still opposes the legislation even with the proposed changes, according to an aide.
The House administration and leadership can only afford to lose about 20 votes from the Republican ranks. They need to shore up support from moderate Republicans who fear that the bill dismantles the Health Care Act Affordable President Barack Obama harms millions of Americans enrolled in the program.
However, Trump and Republican leaders must also appeal to far-right conservatives who believe the original bill did not go far enough to repeal the law, prompting some to call it “Obamacare Lite.”
According to Republican sources who asked not to be named, House leaders will propose a fund of approximately $ 85 billion for tax credits to help people ages 50 to 64 obtain health insurance.
In an unusual move, the House proposed giving the Senate flexibility to offer more help to that age group, who may need a larger tax credit to help cover their health care costs, a move meant to win over more moderate Republicans. He did not specify how the Senate should do it.
Conservatives have opposed refundable tax credits, calling them another rights program.
An amendment would dismantle most Obamacare tax a year earlier than originally proposed in 2017 instead of 2018. That includes both the individual mandate requiring all purchase health insurance or pay a penalty, and the requirement that employers of a certain size provide coverage.
The new language also refers to Medicaid, the federally backed healthcare program for the poor and disabled that is one of the most contentious aspects of the bill.
To appease conservatives, states would have the option of implementing work requirements for healthy adults without children or dependents. However, even the Heritage Foundation, a powerful conservative group, has opposed such a provision.
Additionally, states could decide whether to accept per capita allocations for their Medicaid programs or block grants for certain populations. Both would drastically reduce federal Medicaid funding from current levels.
Republican leaders hope to move the legislation to the House floor for debate on Thursday.
At a rally in Louisville, Kentucky, on Monday night, Trump said he wanted to add a provision to the bill that aims to reduce prescription drug costs through a “competitive bidding process”.
“We are trying to add it to this bill and if we cannot, we will have it immediately afterwards,” he said. During the presidential campaign, Trump called for allowing Medicare to negotiate with drug companies, something the law currently prohibits.
The Congressional Budget Office (CBO) analysis of the original House Republican bill a week ago seriously damaged their prospects. He said 14 million people would lose health coverage under the measure over the next year and 24 million over the next decade.
The CBO is expected to update its analysis of the impact of the legislation to take into account the latest proposed changes.
Under the restructured legislation, the rollback of Obamacare’s Medicaid expansion, which provided states with increased federal funding for new enrollees, would slow.
More than 30 states, including a dozen with Republican governors, chose to expand their Medicaid programs under Obamacare. Several key Republican governors and senators and members of the House have raised concerns about abruptly cutting federal Medicaid funding and thereby uninsuring millions of people.
Republican leaders now propose that many of those who gained coverage with the expansion could keep it. The federal government would maintain the highest funding levels for those up to 133 percent of the federal poverty level. Obamacare expanded coverage to those earning income up to 138 percent.
Those beneficiaries could keep their coverage until they “cancel” the program, possibly because they would eventually earn enough money to buy private insurance or get it through an employer.
Another amendment would allocate more money for health care costs for the disabled and the elderly with Medicaid. The unusual combination of Medicaid amendments reflects the leaders’ attempt to allay the concerns of both staunch conservatives and moderates.
Democrats oppose the Republicans’ plan, who say it would cut millions from health insurance and hurt the elderly, the poor and working families while lowering taxes on the rich.
Democrats, hospitals and insurers alike have urged Republicans to consider how their plan would affect access to health care for the 20 million people insured by Obamacare.