Healthcare Key to Government Shutdown

MedPage Today – by David Pittman

WASHINGTON — A fight over whether to shut down the government unless the Affordable Care Act is defunded continued on Thursday, 1 day after Republicans released their plan for replacing the 2010 health law.

The Republican Study Committee (RSC) on Wednesday released the American Health Care Reform Act, which ties many GOP-fostered ideas into a 181-page bill. The Republican-controlled House is expected to vote Friday on a “stop-gap” measure that would fund the government for a few months but would also defund the ACA.  

The Republicans’ ACA replacement bill, a product of the Republican Study Committee and Health Care Working Group Chairman Phil Roe, MD (R-Tenn.), implements medical liability reform, increases use of health savings accounts, and provides tax deductions to purchase insurance.

The legislation comes after political jabs from President Obama, who has remarked recently that Republicans don’t have an ACA-replacement plan despite more than three dozen repeal votes in the House since the party took over in 2011.

“I came to Congress because, as a physician, I wanted to help shape policy to reform our nation’s healthcare system,” Roe said in a press release. “Unfortunately, during the Obamacare debate, no one asked me or any of the other Republican doctors what we thought, despite requesting several meetings with the president because I saw this train wreck coming.”

Under the legislation, individuals purchasing a qualified health plan would receive a $7,500 tax deduction for health insurance. The deduction would be $20,000 for families and increase with inflation.

Individuals would receive the full deduction even if all the money doesn’t go to purchasing insurance. This would incentivize lower-cost plans, Republicans said, and allow individuals to maintain coverage when they switch jobs — another Republican staple of health reform.

The bill would increase allowable contributions to health savings accounts and allow for larger benefits for wellness plan participation.

It would fund $25 billion over 10 years for state high-risk health pools. Premiums in the pools would be capped at 200% of the average premium in the state.

The Republican bill would also provide coverage for pre-existing conditions, a popular aspect of the ACA. It would also allow individuals to purchase health insurance across state lines, and small businesses could pool together to negotiate better rates.

The American Health Care Reform Act also addresses liability reform by placing a cap on non-economic damages and limiting attorneys’ fees.

Lastly, the bill also bans federal funding for abortions.

“This bill relies on patient-centered solutions while addressing critical reforms,” Renee Ellmers (R-N.C.) said in a release. “This is only the beginning as we continue to fight for all Americans and prevent the danger lurking on our doorstep with the implementation of Obamacare set to take effect on October 1st.”

But the newly filed bill hasn’t yet won the support of at least one Republican physician legislator. Rep. Mike Burgess, MD (R-Texas), didn’t say Thursday if he would support the bill, saying he hasn’t had time to look at it and admitted he “didn’t have much to do with it.”

“There’s just a lot of pent up demand to get something done, to have a Republican alternative, and this is what that particular group in RSC came up with,” Burgess told MedPage Todayafter a Heritage Foundation event Thursday afternoon.

Burgess, an outspoken critic of the ACA, chairs the Congressional Health Care Caucus and has been active in the development of federal healthcare legislation.

“I have worked on alternatives [to the ACA] for the last 4 years,” Burgess said. “Many of the ideas that are incorporated into that are things that we have worked on, legislation we’ve worked on in the past.”

The proposal was heavily criticized by Democrats and progressive groups. “If … all of this sounds familiar, it’s because Republicans have been proposing some combination of these ideas since at least 2007,” wrote Sy Mukherjee in a blog post for, a left-leaning public interest group.

“President George W. Bush proposed the standard deduction idea during his January 2007 State of the Union address,” Mukherjee continued. “At the time, the Center for American Progress criticized the plan as one that ‘would do little to help the uninsured and could replace the employer health insurance system with individual coverage that in most states is inaccessible and unaffordable to many.'”

State-run high-risk pools, supported by Sen. John McCain (R-Ariz.) in his 2008 presidential campaign, have been criticized for being “plagued by waiting periods, premiums that are out of reach for many families, high deductibles and co-pays, and limits on many types of specialty care such as mental health and maternity care services,” Mukherjee noted.

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