Georgia Republicans are sharply divided over the GOP proposal to replace the Affordable Care Act that's galloping through the U.S. House of Representatives, raising concerns about the lack of a cost estimate for the overhaul and its impact on the state's budget as it moves through Capitol Hill.
As House lawmakers prepare to vote on the sweeping rewrite of health care policy, at least two GOP congressmen from Georgia said they won’t support the measure in its current form. And Gov. Nathan Deal has raised concerns about how it will affect Georgia and other states that refused to expand Medicaid.
The fight over the plan is another stinging reminder of the challenges of making substantial changes to health policy — spending on which accounts for more than one-sixth of the country’s gross domestic product, according to the World Bank — even for Republicans who have long vowed to repeal the signature law of Barack Obama’s presidency.
Under pressure from President Donald Trump, who has endorsed the plan, House GOP leaders have signaled they would make only minor changes to the proposal. Democrats, health care industry groups and other critics, meanwhile, are eagerly trying to fan the flames of a budding revolt. Conservative groups aren’t happy either, taking issue with the bill’s refundable tax credits that they say are akin to a new federal entitlement.
The backlash is unfolding as the bill moves at a quickened pace through Capitol Hill. It cleared two House committees this week, even as some GOP congressmen urged for more time to vet the proposal — and it drew unfavorable comparisons to the breakneck pace toward passage of Obama’s health plan in 2009 and 2010.
Its fate is even more uncertain in the Senate, where conservative hard-liners and GOP moderates alike have raised concerns about the plan as written.
The American Health Care Act would reverse the requirement that Americans obtain health coverage or pay a tax penalty, and it would also repeal a mandate that businesses with at least 50 staffers provide insurance. It would also replace income-based subsidies with tax credits and phase out some Medicaid funding over time.
“We’re off to a good start with this plan to get to where we want to be, and that is with an affordable, accessible, patient-centered health care plan,” said U.S. Rep. Buddy Carter, R-Pooler.
Health advocates are fighting a repeal of a public health fund that has become a key part of the Atlanta-based U.S. Centers for Disease Control and Prevention’s budget. And conservative critics are fuming about the plan’s reliance on tax credits to help people afford insurance, which they see as a publicly funded subsidy and have dubbed “Obamacare Lite.”
“We are concerned that if it passes as is, it will benefit the insurance industry and Washington will prove once again it has forgotten about the hardworking men and women of America,” said Jenny Beth Martin, a co-founder of the Tea Party Patriots who was part of a group of conservatives who met with Trump late Wednesday to discuss the plan.
They ‘took the bait’
The proposal would make dramatic changes to Medicaid, which Republican leaders have long cast as financially unsustainable and in need of an overhaul.
The plan would allow the more than two dozen states that have expanded the Medicaid program to continue receiving the generous federal funding until 2020. But the enrollment under the expansion would freeze in 2020, meaning that states adding new residents to the rolls after that would do so without the federal government covering nearly all their costs.
For Georgia and other states that have not expanded their Medicaid programs, the GOP plan would provide $10 billion over five years for health care funding. That puts Georgia in the tricky position of deciding whether to expand the program — despite repeated vows from Deal — or accepting the payout.
In a Thursday interview with The Atlanta Journal-Constitution, Deal said he empathizes with Washington lawmakers confronting a debate that “does not lend itself to easy answers” but said little more about the debate ahead.
Before the measure was introduced, though, he recounted a call with fellow Republican governors who he said “took the bait” and expanded Medicaid with the promise that the federal government would pick up the bulk of the bill.
“I would remind Republican governors who expanded Medicaid — that was part of Obamacare. And now it could very well go away. I am sympathetic to what they did, but we don’t want to be punished for what those states did,” he said. “There are all sorts of quirks in the process that need to be worked out.”
The issue is why two conservative Georgia Republicans say they cannot support the bill in its current form. U.S. Reps. Barry Loudermilk of Cassville and Jody Hice of Monroe said the measure leaves in place too many components of the Affordable Care Act.
“In Georgia we took a stand and said we weren’t going to expand the Medicaid rolls, we took the lumps,” Loudermilk said. “And yet (the bill) is going to reward the states that didn’t by allowing them to continue to expand Medicaid, which further increases the rolls and the costs of this.”
Others have criticized Republican leaders for moving forward with consideration of the legislation before Congress’ nonpartisan scorekeeper has had a chance to determine the bill’s exact cost and how many Americans would gain or lose insurance.
‘A lot of work ahead’
Most Republicans in Georgia’s congressional delegation have sounded positive notes about the health care plan, although many took pains to emphasize that the bill is still a work in progress.
U.S. Rep. Doug Collins called it a “common-sense approach to health care reform” while U.S. Rep. Tom Graves said Trump and House Republicans are fixing the “broken promises” of the Obama White House.
“There’s a lot of work ahead,” Graves said, “but this marks the beginning of a smooth and stable transition to a much better health care system for America.”
Even Loudermilk and Hice said they were looking for ways to get to a “yes” on the plan.
“This is a process,” he said. “It’s not time to hit the panic button yet.”
For the crowded field of candidates hoping to join them in Congress, the divide has proved an early test. Several of the 11 Republicans in the race to replace Tom Price urged House leaders to go back to the drawing board. Others candidates running as Trump loyalists were unequivocal.
“I stand by President Trump 100 percent,” Bruce LeVell, a Dunwoody businessman, said when asked whether he backed the plan.
Georgia Democrats, meanwhile, have taken a “you break it, you buy it” approach.
"This travesty of a proposal should not cause division," state House Minority Leader Stacey Abrams said. "It should bring good Georgians together in solid opposition."
