Next week, the House Energy and Commerce Committee — which is playing a central role in drafting an Obamacare replacement — will hold a pair of hearings on key policy topics: lowering insurance costs and reforming Medicaid, according to a person familiar with the plans. Crucially, the person said, legislation sponsored by committee leaders will be introduced proposing specific reforms in those areas, in what can be considered the first pieces of the GOP health-care replacement plan.
Those hearings, chaired by Health subcommittee Chairman Rep. Michael C. Burgess (R-Tex.), could set the tone and tempo for the House GOP health-care efforts to follow. They will come days after Republican lawmakers meet in Philadelphia to hear from President Trump about his legislative agenda and to discuss policy plans among themselves.
Republican leaders have indicated that they intend to replace the ACA in a piecemeal manner rather than in one fell swoop, and the Energy and Commerce hearings — and bills that will be introduced to accompany them — appear to focus on smaller-bore policy issues.
Zach Hunter, an Energy and Commerce spokesman, confirmed that hearings are planned but did not specify details.
“Next week, the committee will begin taking action on legislation to help rebuild our health-care system with thoughtful, step-by-step reforms in order to bring badly needed relief to patients and families across the country,” he said.
Rep. Greg Walden (R-Ore.), the Energy and Commerce chairman, said last week in a Politico interview that he would embark on a swift but careful mission to overhaul the ACA: “We need to work aggressively on the repairs to the individual market, to Obamacare. Some might call that replacement. I call that a rebuild. I call it repair.”
One hearing, the person familiar with the committee’s plans said, would focus on how to get more younger and healthier people to buy insurance by allowing insurers more flexibility in setting “rating bands” — that is, the difference between the rates that insurers charge younger people and older people in the individual insurance market.
The ACA limited that differential, restricting premiums for older buyers to three times what younger buyers pay. That made insurance more affordable for older and sicker Americans, but increased premiums for younger and healthier folks — many of whom have chosen to forgo insurance and instead pay a tax penalty. Republicans are looking at expanding flexibility to a 5-to-1 ratio and giving states more freedom to adjust those differentials.
That hearing, the person said, will also look at loosening federal rules that allow individual insurance buyers to “game the system” by taking advantage of regulations that provide for a 90-day “grace period” of coverage even if an individual fails to pay his or her premiums. Planned legislation would reduce that period to 30 days, and it would crack down on “special enrollment periods”— that make it easier for individuals to wait until they get sick before buying insurance — by toughening eligibility checks.
A second hearing and accompanying legislation will focus on Medicaid reforms, the person said, though it is likely to steer clear of the broader debate over whether the program will be converted into a fixed “block grant” to states rather than the existing open-ended entitlement. That prospect has generated mixed reactions from governors of states that have expanded Medicaid under the Affordable Care Act, extending health coverage to millions across the country.
Rather, it will be focused on narrower issues: making sure that only verified U.S. citizens or legal residents receive Medicaid benefits, and closing a loophole that allows winners of lottery jackpots to claim Medicaid benefits, as well as a loophole that can allow married couples to shield assets by purchasing an annuity for one spouse to qualify for Medicaid.
In the preliminary hearings Tuesday, which were not called to examine a particular piece of legislation, the other committees appeared to take a broader view of the ACA and how it might be undone and replaced.
“In the coming weeks, we’ll consider legislation that will roll back some of the worst aspects of this law and begin laying the foundation for patient-centered health care, and we already have great ideas to build on,” said Rep. Diane Black (R-Tenn.), interim chairwoman of the House Budget Committee, citing plans introduced by individual GOP lawmakers, as well as a health-care blueprint endorsed last year by House Speaker Paul D. Ryan (R-Wis.).
Democrats made clear that they are skeptical that GOP lawmakers would be able to forge a replacement that better addresses coverage and affordability in American health care — and showed no signs of agreement with Republicans on any of the significant policy issues.
“I expect my Republican colleagues today will wave around bills and claim they have a plan to replace the ACA — they do not,” said Rep. John Yarmuth (D-Ky.), the top Democrat on the budget panel, in his opening remarks Tuesday. “The reality is that in nearly seven years, Republicans have yet to introduce a single bill that has the support of the majority of their conference or comes close to matching the ACA’s record of success.”