Months after President Donald Trump declared the GOP would become the “party of health care,” House conservatives are set to announce a sweeping health care proposal – one that has virtually no chance of becoming law.
The Republican Study Committee on Tuesday unveiled what members described as a “framework,” nine months in the making, even as the White House continues to develop its own set of principles behind closed doors. It includes no legislative text and does not have the formal backing of the White House or broader GOP conference. The conservatives behind it hope the plan could help inoculate Republican congressional candidates against the perception that Republicans have no ideas for fixing a system they’ve vowed to destroy.
But the proposal comes as the attention of Washington is focused squarely on the mushrooming impeachment scandal engulfing Trump’s presidency. And it recycles some of the policies that Republicans tried and failed to advance during the 2017 health care debate, when they controlled both chambers of Congress. That raises questions about how they plan to get a different result a second time around.
The conservative caucus says its plan, titled “A Framework for Affordable, Personalized Care,” will protect coverage for those with pre-existing conditions, a top priority for many Americans. The concern that Republicans would weaken the Affordable Care Act’s protections helped doom the GOP plan to repeal and replace the law in 2017 and was one reason Democrats, many of whom ran campaigns focused on health care, recaptured the House in the 2018 midterm elections.
The plan contains several elements that were in those 2017 replacement proposals, which narrowly fell short of enough Republican support to pass the Senate at the time. It would create federally-funded, state-run insurance pools to cover people with high-cost illness. For instance, states could establish high-risk pools, which existed before the Affordable Care Act with mixed levels of success, or institute reinsurance programs to stabilize the health care market.
And it pushes another favorite Republican measure: combining federal funding now used for Obamacare premium subsidies and Medicare expansion into block grants given to states to help low-income Americans pay for their health care. Several GOP proposals in 2017 also contained block grants, but those raised concerns because Congressional Budget Office analyses found that it would lead many people to lose their coverage over time.
A senior Democratic aide said the Republican Study Committee’s proposal is unlikely to advance in the legislative process, slamming the proposal as a threat to Americans’ health care.
“It’s even worse than what passed out of the Republican House last Congress,” the aide said. “The whole notion of that sort of block granting idea just rips out even more of the protections.”
The RSC plan also calls for extending legislation that provided protections to Americans with job-based insurance to people in the individual market. That law, the Health Insurance Portability and Accountability Act of 1996, known as HIPAA, limits insurers’ ability to deny coverage to those with pre-existing conditions who are starting a new job, switching jobs or moving from a worked-based plan into the individual market. The proposal would curb insurers’ ability to deny policies to those shifting plans on in the individual market, as long as they were continuously covered.
The committee would also boost health savings accounts, which allow Americans to sock away money tax-free for health-related expenses. This is another favored mechanism among Republicans, but critics have said it does little to help those who don’t have funds to set aside for health care bills.
House Republicans are rolling out their complex plan as Trump struggles to articulate broad ideas for the nation’s health care, and as Democrats campaign across the country on an easy-to-explain vision for extending coverage to everyone.
Rep. Roger Marshall, R-Kansas, and Rep. Mike Johnson, R-Louisiana, the chairman of the RSC, said Monday that they had spoken to White House policy directors and acting chief of staff Mick Mulvaney over the weekend as they prepared to publish their lengthy health care report this week, but they noted the White House is continuing work on another parallel plan.
That plan – so far a patchwork quilt of health care proposals that Trump’s team hopes will stack up to a comprehensive vision – will serve as the White House’s answer to the growing support on the left for the kind of universal health care system that Republicans have spent years warning against.
“The White House welcomes the RSC announcement and their contributions to improving our healthcare system,” Judd Deere, White House spokesman, told CNN. “The Trump Administration continues to work to improve healthcare more broadly, which includes creating a system that protects the vulnerable and those with pre-existing conditions and delivers the affordability Americans needs, the choice and control they want, and the quality they deserve.”
Health and Human Services Secretary Alex Azar and Seema Verma, administrator for the Centers for Medicare and Medicaid Services, both said they haven’t discussed the congressional proposal with the RSC. Both Azar and Verma are deeply involved in helping the White House craft its forthcoming set of health care principles.
The House GOP plan comes against the backdrop of a court case that has the potential to upend the nation’s health insurance system and the 2020 election campaign. Federal appellate court judges in Louisiana are now considering a case brought by a coalition of Republican-led states, and backed by the Trump administration, that argue Obamacare as a whole is unconstitutional because Congress essentially eliminated the penalty for not having health insurance, the so-called individual mandate. A US District Court judge in Texas in December sided with the Republican states.
The Trump administration has chosen not to defend the law, leaving many Republicans concerned that they will not have a replacement ready if the appellate court upholds the lower court’s ruling. Democrats are already attacking Trump and the GOP for threatening the coverage of millions of Americans, and if the court invalidates the ACA, Republicans could be left with the blame for dismantling the country’s health care system without preparing a realistic replacement.
“We may have the only ideas on the table to fill that void,” Johnson said, explaining the rush among RSC members to move ahead with the outline of a plan now, a year out from the 2020 election.
The court case could be decided before the end of the year. Regardless of what happens at the appellate level, though, the law’s ultimate fate likely rests with the Supreme Court, and that process could stretch well into next year – setting up the possibility that the White House could secure the verdict on Obamacare it has always sought, and yet risk alienating millions of Americans heading into a contentious election by creating uncertainty around access to medical care.
Marshall, the chair of the RSC health care task force, said he still believes health care will be the “defining issue” of the 2020 election.
“Do you want a president who wants to have the government take over your health care, or do you want personal choices?” Marshall said Monday. “So even though there’s impeachment and all those other things going on here, I think this – healthcare – is the issue of 2020.”