Mar 13, 2017
“Repeal & Replace” is on the move! The American Health Care
Act is the Republican plan to partially repeal the Affordable Care
Act and it is quickly moving through Congress. In this episode,
discover exactly what the bill would do if it were to become law.
Also, Jen gives status updates on bills listeners are concerned
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Read The Bill: The "Repeal &
Replace" of The Affordable Care Act Part 1 Summary:
House Energy & Commerce Summary Part 2 Summary:
House Ways & Means Committee Summary
Title I - Energy & Commerce
Subtitle A - Patient Access to Public Health
- Sec. 101: Defunds the Prevention and Public Heath
Fund at the end of 2018
- Sec. 103: Prohibits any Federal funding for any non-profit that
performs abortions for a year
Subtitle B - Medicaid Program Enhancement
- Sec. 111: Reduces Medicaid funding
- Sec. 112: Repeals the Medicaid expansion
- Sec. 112 (c): Repeals the requirement that Medicaid cover
"essential health benefits" as of January 1, 2020.
- Sec. 114: Prevents Medicaid for lottery winners
- Sec. 115: Gives $10 billion extra to the "non-expansion
- Sec. 116: Forces States to verify Medicaid eligibility every
six months, gives them more enforcement money, and allows $20,000
fines for ineligible people who get Medicaid benefits.
Subtitle C - Per Capita Allotment for Medical
- Sec. 121: Caps Medicaid funding on a per capita basis. States
that spend too much one year will have their Medicaid cut more the
Subtitle D - Patient Relief and Health Insurance Market
- Sec. 131: Repeals the lower out-of-pocket limits for low-income
people effective in 2020
- Sec 132: Creates a $15 billion a year fund (which is reduced to
$10 billion a year starting in 2020) for propping up the health
insurance market by paying for "high risk" sick people
- Sec. 133: Starting in 2019, people who purchase insurance after
a coverage gap of 63 days will be charged a 30% penalty for a year.
The insurance companies get to keep all the extra money.
- Sec. 134: The requirements that bronze, silver, gold, platinum
level plans exist and must cover certain percentages of expenses
health benefits" are repealed effective January 1, 2020.
- Sec. 135: Allows insurance companies to charge older people
five times more than younger people (they're currently allowed to
charge three times more)
Part 2: Tax Provisions Prepared by the Ways and Means Committee
Page 67: Remuneration from Certain Insurers
Page 68: Repeal of Tanning Tax
- Starting in 2018, the 10% tax on indoor tanning is
Page 69: Repeal of Tax on Prescription Medications
- Starting in 2018, a fee paid by pharmaceutical manufacturers
& distributors will be repealed
- This will save the industry $2.8 billion per year
Page 69: Repeal of Health Insurance Tax
- Starting in 2018, a fee on large health insurance companies,
which is tied to and increases with premium growth rates, would be
- This will save the industry approximately $14 billion per
Page 70: Repeal of Net Investment Income Tax
- Starting in 2018, a 3.8% tax on net income from stock market
investments over $200,000 will be repealed
Page 71 (Section 1): Recapture Excess Advance Payments of
Premium Tax Credits
- Starting in 2018, the limits on the amount of advanced-paid tax
credits that can be taken back from low income people will be
Page 71 (Section 2): Additional Modifications to Premium Tax
- Allows tax credits to be used on "catastrophic-only" health
insurance plans that are not listed on the exchanges and prohibits
tax credits for any plan that covers abortions.
Page 80 (Section 3): Premium Tax Credit
- Repeals tax credits for premiums starting in 2020.
Page 81 (Section 4): Small Business Tax Credit
- Repeals the tax credit for employers with fewer than 25
employees who want to provide health benefits to their employees
starting in 2020 and prohibits tax credits for any health plan that
Page 84 (Section 5): Individual Mandate
- Reduces the tax penalties for failing to purchase insurance to
$0 and back dates it to be effective in 2016.
Page 84 (Section 6): Employer Mandate
- Reduces the tax penalties for employers who fail to provide
health benefits to their employees to $0 and back dates it to be
effective in 2016.
Page 85 (Section 7): Repeal of the Tax on Employee Health
Insurance Premiums and Health Plan Benefits
- Delays the start of a tax on insurance companies which charges
a 40% excise tax on "Cadillac
plans", which charge premiums more than $10,200/year
($850/month) for individuals until 2025. The 40% is only on the
extra premiums charges above the cap.
- Currently aren't scheduled to take effect until 2020.
Page 85 (Section 8): Repeal of Tax on Over-The-Counter
Page 86 (Section 10): Repeal of Limitations on Contributions to
Flexible Savings Accounts
- Starting in 2018, the $2,500 limit on the amount that can be
taken out of an employee's paycheck for employer health plans that
use "flexible savings accounts" is repealed starting in 2018.
Page 87 (Section 11): Repeal the Medical Device Tax
- Starting in 2018, repeals a 2.3% tax,
paid by manufacturers or importer, on sales of medical devices that
are not generally purchased by the general public at retail
Part 89 (Section 14): Repeal of Medicare Tax Increase
Summary says that this section should change the tax for
Medicare Hospital Insurance, but the text to be inserted is
identical to current law
Repeal Bill Current Law Page 90 (Section 15): Refundable Tax Credit for
- Creates a new tax credit structure tied to age instead of
income for people making under $75,000 per year (the credits
gradually reduce the more you make over $75,000)
- Under age 30: $2,000/yr
- Ages 30-40: $2,500/yr
- Ages 40-49: $3,000/yr
- Ages 50-59: $3,500/yr
- Over age 60: $4,000/yr
- The credits are capped at $14,000 per family for the five
Page 120 (Section 16): Maximum Contribution Limit to Health
Savings Account Increased to Amount of Deductible and Out-of-Pocket
- Starting in 2018, increases the amount than can be put in
Health Savings Accounts
- Individual contribution limit raised from $2,250 to $5,000 per
- Family contribution limit raised from $4,500 to $10,000.
Bills Discussed in this Episode
58: Providing for congressional disapproval under chapter 8 of
title 5, United States Code, of the rule submitted by the
Department of Education relating to teacher preparation issues
- Kills a rule that assesses the quality of teacher preparation
69: Providing for congressional disapproval under chapter 8 of
title 5, United States Code, of the final rule of the Department of
the Interior relating to “Non-Subsistence Take of Wildlife, and
Public Participation and Closure Procedures, on National Wildlife
Refuges in Alaska”
720: Lawsuit Abuse Reduction Act of 2017
- Forces courts to sanction lawyers for filing lawsuits deemed
725: Innocent Party Protection Act
- Changes the procedures for state lawsuits being heard in
985: Fairness in Class Action Litigation Act of 2017
- Class action lawsuits could only go forward if each person
suffered the same type and scope of injury.
38: Concealed Carry Reciprocity Act of 2017
- Allows people to carry concealed handguns in other states that
issue concealed carry permits, in school zones, and on federally
owned public land.
83: Mobilizing Against Sanctuary Cities Act
- Cuts off federal funds to cities that refuse to give the feds
information about undocumented immigrants.
147: Prenatal Nondiscrimination Act (PRENDA) of 2017
- Applies fines and up to five years in prison to any doctor that
tries to perform an abortion or helps a woman get an abortion if
they know it’s because of the sex or race of the child.
354: Defund Planned Parenthood Act of 2017
- Prohibits funding for Planned Parenthood for a year unless they
promise to not perform abortions. Gives money to community health
610: To distribute Federal funds for elementary and secondary
education in the form of vouchers for eligible students and to
repeal a certain rule relating to nutrition standards in
- Repeals the
Elementary & Secondary Education Act of 1965, which was
enacted as a part of Pres. Lyndon Johnson’s ‘War on Poverty’, which
is a commitment to equal access to quality education by giving
money to low-income districts.
- Creates a voucher program that will give parents tax money to
send their kids to private schools or home school
- Repeals nutrition standards for foods served in the school
lunch and breakfast programs.
756: Postal Service Reform Act of 2017
- Changes the postal service health benefits program and pension
- Changes post office operations: Stops door delivery to new
addresses and changes how rates are determined in a way that
doesn’t create an unfair competitive advantage for the post
785: National Right-to-Work Act
- Prevents labor unions from forcing workers to pay dues
(bankrupts unions by forcing them to provide services to non-paying
861: To terminate the Environmental Protection Agency.
881: AMP Act
- Amends copyright law to provide royalties to music producers,
mixers, or sound engineers
899: To terminate the Department of Education S.
21st Century Endangered Species Transparency Act
- To amend the Endangered Species Act of 1973 to require
publication of the basis for determinations that species are
endangered species or threatened species.
Republicans Give Rich Investors a Tax Break in Obamacare Revamp
by Ben Steverman, Bloomberg, March 8, 2017.
ACA Repeal Would Mean Massive Cuts To Public Health, Leaving Cities
And States At Risk by Chrissie Juliano, Health Affairs Blog,
March 7, 2017.
Health insurance companies would get $1 billion or more windfall
under GOP Obamacare replacement plan by Dan Mangan, CNBC, March
Republican Health-Care Bill Is the Worst of So Many Worlds by
David Dayen, The Nation, March 7, 2017.
Health insurance industry rakes in billions while blaming Obamacare
for losses by Amy Martyn, Consumer Affairs, November 1,
Sound Clip Sources
Watch on CSPAN:
Part 1 -
Part 2 -
Part 3 -
CSPAN Timestamps & Transcripts
- 13:24 Rep. Kathy Castor: This bill
was released less than 48 hours ago without a bipartisan
Congressional Budget Office score, so we don’t know how much it’s
going to cost. Experts say it’s going to add to the deficit. We
don’t know how many people are going to lose their insurance and
how high the uninsured rate will go up in America because of this
bill, because they didn’t take the time to wait, to see what that
CBO score said.
- 3:05:25 Rep. Steve Scalise: We’ve
asked CBO, by the way, for a score. Anybody who thinks we’re going
to just wait and let some unelected bureaucrats in Washington stop
us from following through on our promise to the American people
that we’re going to repeal this failed law and finally rescue them
from the double-digit increases in premiums and from the $10,000
and more in deductibles and all the other things that have
destroyed good healthcare for them, we’re going to keep moving
forward and fulfill that promise because the American people expect
us to do it, they want us to do it, and CBO’s eventually going to
come up with a score before it goes to budget committee, before it
goes to the House floor. But in the meantime, if they can’t get the
score out there, we’re still going to move forward and follow
through on that promise.
- 3:15:10 Rep. Joe Barton: We’re all
God’s children; we all want a CBO score. It’s not our fault that
the CBO’s sitting on their bottom and not helping us.
- 8:35:34 Rep. Gus Bilirakis:We should
be making it easier for small businesses to grow and succeed, not
- 9:10:35 Rep. Frank Pallone: The
problem that I see, though, is that—so, you and the others continue
to talk about how bad the ACA is, and my point earlier when I
mentioned you by name was because I’d like to see how you feel that
your bill is going to improve any of these things. Now you
mentioned deductibles. The way I read this bill—I’m not going to
ask counsel because I read it, and I think it’s clear—the
restrictions that we put on—or that have made it more difficult to
increase deductibles with a private-insurance market, a lot of
those are relaxed now. So I would venture to argue that if you have
someone who’s complaining about deductibles, those deductibles are
going to go up even more. Rep. John Shimkus: Yeah,
but if I reclaim my time because, as you know, we’ve got two bills
moving through the write at the same process that the benefit of
what’s going on now is you talk to our friends in Ways and Means is
the strong development of health savings accounts, which fills that
gap, right? You buy insurance for a higher cost. If you live
healthy lifestyles, you’ll be able to roll that over, the
catastrophic number gets better, your payments get less if you
believe in markets and competition.
- 10:16:45 Rep. Mike Doyle: I’m not
sure what the gentleman is talking about when he talks about
mandates. What mandate in the Obamacare bill does he take issue
with? Certainly not with preexisting conditions or caps on benefits
or letting your child stay on the policy to 26. So I’m curious,
what is it we’re mandating— Rep. John Shimkus:
Will the gentlemen yield? Doyle: Yeah, sure.
Shimkus: What about men having to purchase
prenatal care? Doyle: That—what—
Shimkus: I’m just— Doyle:
Every—that’s very— Shimkus: Is that not correct?
Doyle: I—reclaiming my time.
Shimkus: And should they? Doyle:
Reclaiming my time. Chairman Greg Walden: Whoa,
whoa, whoa— Doyle: There’s no such thing—
Walden: —whoa, whoa, whoa. Doyle:
—as à la carte— Walden: Regular order.
Doyle: There’s no such thing as à la carte
insurance, John. You know, you don’t get the—
Shimkus: That's the point! Doyle:
—list and say, give me that. Shimkus: That’s the
point! We want the consumer to be able to go to the insurance
market and be able to negotiate— Doyle: You tell—
Shimkus:—on a plan— Doyle:
Reclaiming my time. Walden: Whoa, whoa.
Doyle: You tell me what insurance company will do
that. There isn’t a single insurance— Walden:
Gentleman’s time— Doyle: —in the world that does
that. Walden: The gentleman’s time—the gentle—
Doyle: You're talking about something that doesn't
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