By Joyce Frieden
WASHINGTON — After a marathon 27-hour session, the House Energy & Commerce Committee approved by a vote of 31-23 a GOP bill aimed at replacing many components of the Affordable Care Act, defeating all amendments proposed by the Democrats, including one to block defunding of Planned Parenthood.
Committee chair Rep. Greg Walden (R-Ore.) and ranking member Rep. Frank Pallone (D-N.J.) both thanked the committee staff for all its hard work, although Pallone also noted that it had “not been a transparent process.” After the final vote on the bill, the committee voted down a resolution from Rep. Joe Kennedy (D-Mass.) asking that the Democrats be given copies of emails and documents between the Republican committee staff and the White House related to the next phases of ACA replacement legislation, which Kennedy said he knew nothing about until President Trump tweeted about them Tuesday morning.
The discussion about Planned Parenthood was one of several contentious moments in the session. “In 2015, Planned Parenthood saw 2.5 million patients and provided more than 4 million [sexually transmitted infection] tests and treatments and birth control for 2.1 million people,” said Rep. Diana DeGette (D-Colo.) “In many areas, Planned Parenthood centers are the only safety net provider available to men and women who otherwise would have no reasonable way of getting care. My colleagues across the aisle say community health centers can fill the gap, but those claims have been debunked — including by the [centers] themselves.”
Rep. Marsha Blackburn (R-Tenn.) disagreed. “There are 1,375 federally qualified health centers, according to the Health Resources and Services Administration, and those centers have 10,554 delivery sites and they serve more than 24 million million patients each year,” she said. “This bill doesn’t do anything to change the availability of funds for women’s health; it [just] puts parameters on how those funds can be used. When you talk about delivering women’s health, that’s an important thing to do.”
The amendment was eventually defeated in a 31-23 vote along party lines.
Other amendments the committee voted down through the night and into the early morning would have:
- Required that the repeal bill not take effect until the Congressional Budget Office certified that it would lower costs, make healthcare more affordable, improve the benefits offered, and not increase the uninsured rate
- Struck down the bill’s provision changing federal funding for Medicaid to a “per-capita” arrangement in which states receive a per-capita amount for each Medicaid beneficiary, rather than paying a matching amount based on the amount of money each state spends on Medicaid, as is done now
- Struck down a provision that changes the ratio of the most expensive premium private insurers could charge older people compared with the least expensive premium they could charge younger people from 3-to-1 to 5-to-1
One of the shorter discussions on an amendment involved one that would have repealed a provision calling for a 30% surcharge on new health insurance enrollees who have gone without coverage for 63 days in the 12 months immediately preceding enrollment. “President Trump promised [people] would continue to have the same access to coverage under the GOP repeal plan,” said Rep. G.K. Butterfield (D-N.C.). “The bill we’re marking up today fails to live up to these promises … This [provision] puts people with preexisting conditions at risk of being penalized … and locked out of coverage” if they lose coverage for 2 months or more.
The measure will also result in a “death spiral” in the health exchanges because, rather than encouraging healthy young people to sign up, “they will simply [stay out of the market] and premiums will go up for those in the market,” he said.
Rep. Susan Brooks (R-Ind.) disagreed. “There must be an incentive to enroll in healthcare,” she said. “The Obama administration … chose penalties for everyone that didn’t buy a Washington-mandated product … We don’t plan to mandate, so continuous coverage means encouraging responsibility.” She cited Medicare’s premium penalties for late enrollment as an example of a successful incentive.
The measure was voted down 28-23.
The all-night session followed a day of political posturing by both Democrats and Republicans, but when dawn broke none of the Democrats amendments were included.
The first amendment to the bill by the House Energy & Commerce Committee — which will be combined with a bill passed early Thursday by the House Ways & Means Committee to form a single bill — was a tongue-in-cheek initiative proposed by Rep. Frank Pallone (D-N.J.), the committee’s ranking member, to change the name of the repeal bill from the American Health Care Act to the “Republican Pay More for Less Act.”
“[My Republican colleagues] keep talking about why they don’t like the ACA … But no one really explained how the bill before us is going to improve on any of the things they criticize the ACA for,” Pallone said. “I believe this is nothing more than a message vehicle.”
Rep. Eliot Engel (D-N.Y.) agreed. “People will pay more and get less” with this bill, he said. “The bottom line is, people want to know, ‘What is my coverage and how much am I going to pay for it?’ It seems we have enough brains on both sides of the aisle that we could have put our heads together and come up with a fix.”
Republicans, not surprisingly, opposed the amendment, which was defeated. “I have spent the last seven years discussing healthcare, and the common [refrain] is that my constituents pay more and get less,” said Rep. John Shimkus (R-Ill.). He gave the example of a constituent, a healthy 61-year-old woman, whose health insurance premiums started out at $264 per month a few years ago and rose to $858 per month this year.
The committee was continuing to discuss Democratic amendments on Thursday morning.