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H.R. 1628: House prepares to vote on ACA change bill

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Members of the House are getting ready to vote on a heavily revised version of H.R. 1628, the American Health Care Act bill, today, after getting the text late last night.

The House Rules Committee posted what appears to be the final version of the text here.

At press time, members of the House debating the bill on the House floor. Live video of House floor action is available here. The final vote on the bill could occur around 4 p.m. EDT today.

Related: H.R. 1628 chaos raises odds for ACA survival

House leaders are using a special, expedited, “martial law rule” process to rush the bill to the House floor.

It’s not clear whether the Republican supporters of the bill have enough votes to pass it.

Mick Mulvaney, the Trump administration’s director of the Office of Management and Budget, told CNBC today that the administration wants the House to vote on the bill today.

Many members of the Freedom Caucus, a group for free-market Republicans, appeared to oppose the bill earlier this week. Some Freedom Caucus members, such as Rep. Mark Meadows, R-N.C., seemed to be warming up to the bill Thursday, or at least to be keeping their latest thoughts to themselves, but others, such as Rep. Justin Amash, R-N.C., have continued to speak out against it.

Amash objected to the process the House is using to consider the bill.

“We must have the opportunity to read and understand the final bill before we vote,” Amash tweeted. “It’s irresponsible to do otherwise.”

Earlier this morning, the House Rules Committee, the panel that decides how bills reach the floor, agreed 9-3, with a pure party-line vote, to let the bill come up on the floor today, with fours for debate split evenly between the Republicans and the Democrats.

Rep. Tom Cole, R-Okla., read the rule aloud. He gave a description of the final text that referred to “Part A in the Rules Committee report, modified by the amendment printed in part B” and provided that “the amendment printed in part C of the Rules Committee report, modified by the amendments printed in part D and part E of the report, shall be considered as adopted.”

Rep. Jim McGovern, D-Mass., complained about how Republicans have assembled the bill.

“There are fixes to the fixes to the fixes,” McGovern said.

Rep. Jared Polis, D-Colo., who has repeatedly talked about his interest in developing a bipartisan ACA change bill, said, “I think this body can do better.”

Polis and others said he wished the rule for H.R. 1628 debate would let members offer and debate amendments on the House floor.

Drafters have tried to write the bill as a budget reconciliation measure, or a measure, that, under traditional Senate rules, can get through the Senate with just 51 votes, rather than the 60 votes traditionally needed for a traditional bill.

Because the Senate parliamentarian must agree that a provision in a budget measure is “germane” to federal spending, the complexity of the drafting process makes letting House members propose amendments on the floor impractical, according to Rep. Rob Woodall, R-Ga.

Related: Cruz pushes ACA repeal gambit that could roil U.S. Senate

A look at the bill and the amendments suggests that the final version appears to contain the following:

          • Most of the provisions in the original public version of H.R. 1628.

          • An amendment that would let states impose work requirements on able-bodied adult recipients of Medicaid coverage.

          • A variety of amendments making various ACA tax relief measures available a year earlier than in the original version, and pushing back the start of the ACA Cadillac plan tax on high-cost employer-provided health benefits to 2026, from 2025.

          • An amendment that would keep the 0.9 percent Medicare tax on high earners.

          • An amendment that would let consumers deduct medical expenses from taxable income if excesses exceeded 5.8 percent of adjusted income. The current threshold is 10 percent, and the threshold in the original public version of the AHCA bill was 7.5 percent.

          • An amendment providing an extra $15 billion in funding that states could use for maternity care, mental health care and substance abuse treatment.

          • An amendment that would put states in charge of designing their own essential health benefits packages, or standard benefits that every major medical plan should cover.

Democrats have blasted the essential health benefit (EHB) requirement. A New York Times reporter quoted one management consultant Thursday who quipped that letting states design their own EHB requirements could lead to plans that “cover aromatherapy but not chemotherapy.”

House Rules committee Democrats have argued that many provisions in H.R. 1628 have little or nothing to do with federal spending and will be knocked out of the bill once the bill reaches the Senate.

Some Republicans, such as Sen. Ted Cruz, R-Texas, have argued that Republicans in the Senate could get around budget reconciliation limitations by having Vice President Mike Pence, who is the official president of the Senate, preside over deliberations and classify provisions as being germane to the budget.

If, however, all Senate Democrats and independents oppose H.R. 1628, bill supporters could still have trouble putting together a 51-vote majority in the Senate. Earlier this week, senators such as Cruz, and Rand Paul of Kentucky, were saying that H.R. 1628 appeared to be too much like the ACA, and Republican senators like Susan Collins of Maine were saying the bill appeared to be too hard on Medicaid enrollees.

James Slotnick, a government affairs specialist at Sun Life Financial U.S., has pointed out that Republicans are fighting the calendar if they want to use budget reconciliation to pass both an ACA change bill and a tax reform bill this year. They want to use the 2016 budget window to pass an ACA change bill, and the 2017 budget window to pass a tax reform bill. The 2016 budget window will close in late April.


CBO sees AHCA cutting $337 billion from the deficit

Ryan clings to core of GOP health bill as opposition mounts

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