ACA Update | March 2, 2017: GOP Tax Credits, Medicaid Proposals, and a ‘Secret’ Replacement Bill

In his address to a joint session of Congress this week, President Trump shared his priorities for the replacement of the Affordable Care Act (ACA). David Nather of Axios wrote, “It wasn’t detailed enough to be called a proposal, but Trump outlined enough principles to give a general idea of what he wants. He got more specific on some issues than he has in the past, like calling for tax credits — a nudge to conservative Republicans who don’t like the idea.”

In addition to tax credits and health savings accounts, President Trump mentioned ensuring that people with pre-existing conditions have access to insurance, ensuring a “stable transition” for people with ACA coverage, providing flexibility in state implementation of Medicaid, and allowing insurers to sell plans across state lines (though some experts have said selling across state lines will not be helpful).

Tax credits have become a major issue, with Democrats concerned that the tax credits will not be sufficient to help low-income individuals purchase insurance, and the most conservative Republicans opposed to any kind of subsidy or credits. The legislative text leaked last week had age-based tax credits, as have some of the previous plans proposed by Speaker Paul Ryan and Secretary of Health and Human Services Tom Price. For low-income individuals who need assistance purchasing coverage, age-based tax credits may make insurance unaffordable.

Earlier this week, President Trump met with the nation’s governors as part of the National Governors Association meeting. Many governors have expressed a desire to retain the Medicaid expansion, which 31 states implemented, covering 12 million additional people with enhanced federal funding. Proposals to transition the Medicaid program to a block grant would shift more of the burden to states. Bloomberg reports that a group of Republican governors, led by Ohio’s John Kasich and Wisconsin’s Scott Walker, are developing a proposal to give more control of Medicaid to states, retain coverage levels, and allow states flexibility in how to implement the Medicaid expansion.

Reports from Capitol Hill today indicate that there is a new version of an ACA replacement plan that is being kept secret to avoid leaks. According to Bloomberg, “House Republican leaders have a new version of their major Obamacare repeal and replacement bill. They just don’t want you to see it. The document is being treated a bit like a top-secret surveillance intercept. … The unusual secrecy is a reflection of the sensitivity—and the stakes—surrounding the GOP effort to rewrite the Affordable Care Act.”

While the legislative text is not yet public, some Members have indicated that the bill will be marked up next week, even before the Congressional Budget Office has a chance to estimate the cost and coverage implications of the proposal.

It’s not too late to let your Members of Congress know that access to quality, affordable health insurance is critically important for cancer patients and survivors. Even if you’ve already called, you can call again! If your Senators or Representative are already supportive of the ACA, take a moment to thank him or her. If you have stories of how the ACA has helped you, members of your family, or people you know, please share them with NCCS and with your Members of Congress.

Call your Members of Congress today to let them know the ACA is critical for cancer patients and must not be repealed.
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