American Health Care Act of 2017
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The American Health Care Act was introduced in the U.S. House of Representatives by Representatives Kevin Brady (R-Texas) and Greg Walden (R-Ore.) on March 6, 2017. The House passed the bill 217-213 on May 4, 2017. The bill is a reconciliation bill, meaning it impacts the budgetary and fiscal provisions of the ACA, and does not contain a provision to repeal the law in its entirety. If enacted, it would repeal the tax penalties on individuals for not maintaining health coverage and on employers for not offering coverage. The ACA's income-based tax credits for purchasing insurance would end, as would the enhanced federal funding for states that expanded Medicaid. The bill contains its own system of tax credits, based on age rather than income, and a penalty in the form of increased premiums for individuals who do not maintain continuous coverage.[1]
What's next for the AHCA?
- See also: 115th Congress on the AHCA and House roll call vote on the AHCA
On May 4, 2017, the House voted 217-213 to pass the American Health Care Act. The bill next heads to the Senate for consideration, where it could see additional amendments or changes. Reuters reported on May 4 that the White House "fully expects [the] Senate to tweak" the bill, and Republican Senator Bob Corker (R-Tenn.) said "there was no way the healthcare bill would receive a quick up-or-down vote in the Senate." Corker added that the Senate could spend at least a month considering the bill.[1][2][3]
After the Senate makes its changes, the Senate parliamentarian will rule on whether the bill and its amendments fall under the rules of reconciliation. This is where the bill could run into a procedural hurdle in the Senate. Republican lawmakers had expressed intent to fast-track the AHCA as a reconciliation bill. Reconciliation bills primarily deal with changes in taxes or spending and can bypass potential filibusters in the Senate. Reconciliation bills can pass the Senate with a simple majority of votes (51-49) rather than the 60-vote threshold required to end a Senate filibuster.[4][5]
The reconciliation process is governed by the Byrd rule. The Byrd rule requires reconciliation bills to relate solely to budgetary matters; bill provisions must impact expenditures or revenues. Some portions of the AHCA may be challenged under the Byrd rule, such as the provision allowing states to opt out of federal standards for benefits health plans must offer and how much premiums may vary. Another concern is the provision that would require insurers to increase premiums by 30 percent for one year for individuals who do not maintain continuous health insurance coverage, because the penalty money would go to insurers rather than the government. Under the Byrd rule, the Senate parliamentarian will decide whether this and other amendments are sufficiently budget-related.[6]
If the Senate Parliamentarian deems any provisions as unrelated to the budget, the Senate would have to remove the provisions in order to still pass the bill through the reconciliation process. If the Senate retained these provisions, the bill would no longer fall under reconciliation rules and would need 60 votes to end debate on the Senate floor. In this scenario, Republicans would need Democrats to vote in favor of the bill, but no Democratic members of Congress support repealing the Affordable Care Act.[7]
In March 2017, Senator Rand Paul (R-Ky.) argued that a third option would be for Vice President Mike Pence to overrule the Senate parliamentarian's ruling that the provisions did not fall under the rules of reconciliation. "We've read the rules, and it looks to us like the vice president can sit in the chair, and the vice president can decide for the Senate what is reconcilable," Paul said. However, this action would be unprecedented.[8]
Background
| Budget reconciliation |
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| Unpacking the reconciliation process |
| • How reconciliation works • Why reconciliation is used • History of use • Analysis of use • Limits on reconciliation • The Byrd Rule • Filibuster and reconciliation • Vote-a-ramas |
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The American Health Care Act was introduced in the House of Representatives by Reps. Kevin Brady (R-Texas) and Greg Walden (R-Ore.) on March 6, 2017. The bill drew criticism from both moderate and conservative members of the Republican Party, and by March 24, 2017, 36 Republican representatives had expressed opposition to the healthcare bill. Two amendments were added to the bill in March—one that would have allowed work requirements and block grants in Medicaid, and another that would have repealed the ACA’s essential benefits provision. However, these did little to garner support among Republicans in opposition. The United States House of Representatives was expected to vote on the AHCA on Thursday, March 23, 2017, but the vote was canceled. It was rescheduled for Friday, March 24, but House Republican leaders withdrew the bill amid dwindling support.[9][10]
The House reintroduced the measure on April 6, 2017. On April 13, 2017, House Republicans added a new amendment to the American Health Care Act in an attempt to unite the party behind the bill. The amendment was the culmination of negotiations between Tom MacArthur (R-N.J.), co-chair of the Tuesday Group, the moderate wing of the Republican Party, and Mark Meadows (R-N.C.), head of the House Freedom Caucus, the conservative and libertarian-leaning wing of the party. These two groups could not reach an agreement ahead of a prior scheduled vote on March 24, leading to the bill being pulled before the vote. CNBC reported that the amendment would garner between 18 and 20 new "yes" votes from members of the Freedom Caucus.[11][12]
On April 26, 2017, the House Freedom Caucus said that they would support the AHCA because of the amendment. At the time, it was unclear of members of the Tuesday Group would support the amended bill.[13][14]
On May 3, 2017, Representative Fred Upton (R-Mich.) offered an amendment to the AHCA in an attempt to secure the votes of moderate Republicans. The amendment would provide states with an additional $8 billion over five years to fund high-risk pools for individuals with preexisting conditions. After meeting with President Donald Trump on May 3, 2017, Upton was optimistic that his amendment would get the GOP the 216 votes they need to pass the bill. He said, "I think it is likely now to pass the House."[15][16]
Text of plan
The text below reflects the language of the American Health Care Act as it was passed by the House.
Summary
On March 6, 2017, Representatives Kevin Brady (R-Texas) and Greg Walden (R-Ore.) introduced the American Health Care Act. The reconciliation bill, which would only impact the budgetary and fiscal provisions of the ACA, does not contain a provision to repeal the law in its entirety. It was similar to a draft version of the bill obtained and released by Politico on February 24, 2017.[17]
Individual and benefit mandates
The American Health Care Act would repeal the tax penalties on individuals for not maintaining health coverage and on employers for not offering coverage. Instead, the bill would require insurers to increase monthly premiums by 30 percent for one year for individuals who did not maintain continuous health insurance coverage. The bill would not repeal the ACA's requirement that insurers cover the ten essential benefits outlined by the federal government. However, an amendment added on April 13 would allow states to acquire a waiver from the requirement. This amendment was a change from an amendment added on March 24, which would have repealed the federal essential benefits requirement entirely and required states to determine their own benefits standards.[17]
The bill also would maintain bans on lifetime and annual benefit limits and insurance plans would still be required to cover preventive care at no cost to the patient.[17]
Tax credits and health exchanges
Starting in 2020, the bill would eliminate the ACA's income-based tax credits and subsidies. The bill instead would provide different tax credits based on age. Individuals under 30 would receive a $2,000 annual credit, which would increase by age group up to $4,000 for individuals over the age of 60. The tax credits would be available for anyone not eligible for an employer-sponsored plan or government health program, such as Medicaid.[17]
In the meantime, the ACA's advanced premium tax credits would be increased for young individuals earning incomes above 150 percent of the federal poverty level, and decreased for older individuals earning that amount. Cost-sharing subsidies, which reduce enrollees' share of costs under a plan, would be repealed in 2020.[17]
The health insurance exchanges would remain in operation, as well as the open enrollment and special enrollment periods. However, tax credits could be used for plans sold on or off the exchanges; under the ACA, tax credits could only be used for on-exchange plans.[17]
Insurance market rules and public programs
Insurers would still be prohibited from denying coverage for pre-existing conditions. The bill also would provide $100 billion to states to establish various methods of covering particularly high-risk individuals with such conditions. Insurers also would still be required to allow dependents to remain on their parents' insurance coverage until age 26. However, insurers would be allowed to charge premiums for older individuals as much as five times higher than for younger individuals; under the ACA, premiums for older individuals could only be three times greater.[17]
An amendment added to the bill on March 24 would also provide $15 billion to states to promote access to preventive care, dental care, and vision care, and to provide maternity and newborn care and mental health services. An amendment added to the bill on April 6 would allocate another $15 billion for a reinsurance program, which reimburses insurers for covering high-cost individuals. An amendment added to the bill on April 13 would allow states to acquire a waiver to allow insurers to vary premiums based on health status (like preexisting conditions), as long as the state had established a high-risk pool for individuals with preexisting or costly conditions. In addition, individuals with preexisting conditions would only be subject to higher premiums if they had not maintained continuous health insurance coverage. An amendment added to the bill on May 3 would provide an additional $8 billion over five years to fund high-risk pools for individuals with preexisting conditions.[18][19]
Medicaid
The bill would make statutorily voluntary the ACA's Medicaid expansion, which allowed states to widen eligibility for the program to individuals earning incomes up to 138 percent of the federal poverty level. However, beginning in 2020, no new states could expand their Medicaid programs. Also beginning in 2020, the bill would no longer provide enhanced federal reimbursements for any state spending on individuals that enroll under expanded Medicaid after December 31, 2019.[17]
The original bill also would convert Medicaid financing from an open-ended entitlement to a per-member amount. This amount would be adjusted based on five distinct groups: elderly, blind and disabled, children, expansion adults, and other adults. It also would provide $10 billion over five years in safety net funding for states that did not expand Medicaid. The law would set a target spending amount for states based on fiscal year 2016 expenditures that would increase annually. Beginning in 2020, states that spent more than the targeted amount on their Medicaid programs in any given year would receive a reduced amount of funding the following year.[17]
Under the bill, state Medicaid programs would no longer have to cover the 10 essential health benefits that private plans must cover under the ACA.[17]
Planned Parenthood
The bill would suspend federal funding available to states to make payments to community health centers that provide family planning, reproductive health, and related medical services and also provide abortions. This would include the nonprofit organization Planned Parenthood. The funding would be suspended for one year.[17]
Amendments
The following is a list of approved amendments to the American Health Care Act.
May 3 amendment
On May 3, 2017, Representative Fred Upton (R-Mich.) offered an amendment to the AHCA in an attempt to secure the votes of moderate Republicans. The amendment would provide states with an additional $8 billion over five years to fund high-risk pools for individuals with preexisting conditions. After meeting with President Donald Trump on May 3, 2017, Upton was optimistic that his amendment would get the GOP the 216 votes they need to pass the bill. He said, "I think it is likely now to pass the House."[18][20]
April 13 amendment
On April 13, 2017, House Republicans added an amendment to the AHCA in an attempt to unite the party behind the bill. The amendment was the culmination of negotiations between Tom MacArthur (R-N.J.), co-chair of the Tuesday Group, the moderate wing of the Republican Party, and Mark Meadows (R-N.C.), head of the House Freedom Caucus, the conservative and libertarian-leaning wing of the party.[21]
The amendment would retain the 10 essential health benefits as the federal standard for what health plans must cover, but would allow states to acquire a waiver from the requirement. The 10 essential benefits health plans were required to cover under the Affordable Care Act included the following:[22][23]
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
This portion of the amendment was a change from the amendment added on March 24, which would have repealed the federal essential benefits requirement entirely and required states to determine their own benefits standards.
Other provisions in the ACA that would be retained by the amendment included the prohibition on denying coverage for pre-existing conditions, the requirement to cover individuals on their parents' health plan until age 26, and limits on how much insurers may vary premiums for reasons such as age, gender, and health status (known as community rating).[22]
In addition to waiving the essential benefits standard, the amendment would allow states to obtain waivers from the community rating provisions, except for the rules limiting premium variance based on gender and age. States could only waive the limits on varying premiums based on health status (like preexisting conditions) if they had also established a publicly funded high-risk pool to cover individuals with costly conditions. In addition, individuals with preexisting conditions would only be subject to potentially higher premiums if they had not maintained continuous health insurance coverage.[22][24]
March 24 amendment
On March 24, 2017, the House Rules Committee approved an amendment to the AHCA that would repeal the ACA's requirement that insurers provide federally determined essential health benefits. Under the amendment, each state instead would be required to determine which essential benefits insurers licensed in that state must cover.[25][26][27]
The amendment also would provide $15 billion to states to promote access to preventive care, dental care, and vision care, and to provide maternity and newborn care and mental health services. The $15 billion would be funded by maintaining a 0.09 percent Medicare tax on high-income earners for six years.[27]
March 20 amendment
On March 20, 2017, the House offered an amendment to the AHCA providing extra funding for tax credits for older Americans to help them pay their premiums and instructing the Senate to design the bill's system of tax credits. It would remove a provision in the original bill that would have allowed individuals to deposit leftover tax credit money into a health savings account. The amendment would allow states to establish work requirements for their Medicaid programs and would allow states to receive federal Medicaid funding in the form of a per-member amount or block grants, whichever they chose. The amendment would repeal many of the ACA's taxes and fees and would delay the 40 percent excise tax on employer-sponsored plans until 2026. Finally, the amendment contained a provision specific to New York state: it would prohibit New York from receiving federal reimbursement for Medicaid payments that counties make to the state in an attempt to shift more Medicaid spending to the state level.[28]
Congressional Budget Office reports on the AHCA
Second report
On May 24, 2017, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released a report estimating the cost of the AHCA as amended and its impact on the number of uninsured. Key findings appear below.[29]
- Federal budget: The AHCA would reduce the federal deficit by $119 billion between 2017 and 2026 due to a $1.1 trillion decrease in direct spending and a $992 billion reduction in revenues.
- The bulk of the deficit reduction would come from lower spending on both Medicaid and health insurance tax credits.
- The largest revenue reductions would come from the elimination or modification of the ACA's tax provisions, such as the annual fees imposed on health insurers. Other revenue reductions would come from the elimination of penalties on individuals who do not purchase health insurance and on employers who do not offer it.
- Health insurance: Compared to the ACA, 14 million more people would be uninsured in 2018 under the AHCA, and 23 million more people would be uninsured in 2026. In total, under the AHCA, 51 million people would be uninsured in 2026, compared to 28 million who would be uninsured under the ACA.
- Stability of the health insurance market: The individual insurance market would be stable in most states. According to the report, tax credits would maintain sufficient demand for insurance and grants to states to help cover individuals with high healthcare costs. The report found that markets in some states would become unstable beginning in 2020, due to those states obtaining waivers from some of the laws provisions. In particular, states that obtain a waiver from the requirement to charge all individuals the same premiums regardless of health status would see premiums rise, resulting in fewer people with insurance.
- Effects of premiums: The AHCA would increase premiums by about 20 percent in 2018 and 5 percent in 2019, compared to the ACA. Beginning in 2020, premiums would depend on waivers obtained by states. The report made a few projections based on different scenarios:
- The report projected that half of the country's population resides in states that would not obtain waivers. In these states, premiums would be 4 percent lower in 2026 than under the ACA.
- The report projected that about one-third of the country's population resides in states that would obtain waivers from either the benefits mandate or the requirement to charge the same premiums to all enrollees, resulting in premiums about 20 percent lower in 2026 than under the ACA.
- The report projected that about one-sixth of the country's population resides in states that would obtain waivers from both the benefits mandate and the premiums requirement, resulting in premiums that would be lower than under current law but that would vary widely according to health status. The report did not provide a specific estimate of premiums in this scenario.
First report
On March 13, 2017, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released a report estimating the cost of the AHCA and its impact on the number of uninsured. The key findings appear below.[30]
- Federal budget: The AHCA would reduce federal deficits by $337 billion over the 2017 to 2026 period due to a $1.2 trillion decrease in direct spending, partially offset by an $883 billion reduction in revenues.
- Savings would come from reducing Medicaid funding and eliminating ACA subsidies for nongroup health insurance.
- Costs would come from changes to the tax code, the Patient and State Stability Fund grant program, and increased spending under Medicare. According to the report, "The largest costs would come from repealing many of the changes the ACA made to the Internal Revenue Code—including an increase in the Hospital Insurance payroll tax rate for high-income taxpayers, a surtax on those taxpayers’ net investment income, and annual fees imposed on health insurers—and from the establishment of a new tax credit for health insurance."
- Health insurance coverage: Compared to the ACA, 14 million more people would be uninsured in 2018 under the AHCA, and 24 million more people would be uninsured in 2026. In total, under the AHCA, 52 million people would be uninsured in 2026, compared to 28 million who would be uninsured under the ACA.
- Increases in the number of uninsured would come from repealing the penalties associated with the individual mandate and changes to subsidies and Medicaid.
- Stability of the health insurance market: The market for insurance purchased individually would remain stable under the AHCA because of subsidies to purchase insurance and grants to states from the Patient and State Stability Fund. According to the report, "Even though the new tax credits would be structured differently from the current subsidies and would generally be less generous for those receiving subsidies under current law, the other changes would, in the agencies’ view, lower average premiums enough to attract a sufficient number of relatively healthy people to stabilize the market."
- Effects on premiums: The AHCA would initially increase average premiums in the nongroup market by 15 to 20 percent and then lower average premiums in 2020 compared to projections under the ACA. By 2026, average premiums for single policyholders in the nongroup market would be 10 percent lower than under the ACA.
- The initial rise in premiums would result from the elimination of the individual mandate penalties, which would likely result in healthier individuals leaving the health insurance market. "Starting in 2020, the increase in average premiums from repealing the individual mandate penalties would be more than offset by the combination of several factors that would decrease those premiums: grants to states from the Patient and State Stability Fund; the elimination of the requirement for insurers to offer plans covering certain percentages of the cost of covered benefits; and a younger mix of enrollees," according to the report. The CBO and JCT estimated that premiums would be lower for younger people and higher for older people under the AHCA.
Outside groups and influencers on the AHCA
Support
| American Action Network, "Tell Congressman Labrador to Support the American Health Care Act," March 9, 2015 |
- American Action Network - The American Action Network, a group aligned with Speaker Paul Ryan (R-Wis.), spent $500,000 to run ads that ask the constituents of members of the Freedom Caucus to vote for the AHCA.[31]
- U.S. Chamber of Commerce - Neil Bradley, the U.S. Chamber's senior vice president and chief policy officer, wrote the following in a letter to the Energy and Commerce and Ways and Means Committees: "The U.S. Chamber of Commerce supports the 2017 House Reconciliation Legislative Recommendations. Critically important provisions in the Recommendations repeal a substantial number of the most harmful provisions in the Affordable Care Act: the health insurance tax, the medical device tax, and the tax on prescription medications; restrictions on the use and limitations on contributions to health savings accounts and flexible spending accounts; and the penalties associated with the employer mandate. Just as importantly, the Recommendations preserve the longstanding tax treatment of employer sponsored coverage through which 177 million individuals receive their health care coverage. The Chamber is also pleased that the House is proposing to delay the 40 percent Cadillac tax, and we look forward to working with Congress to eventually repeal the tax completely. These Recommendations and the successful mark-up of the provisions in the Ways and Means and Energy and Commerce Committees tomorrow are absolutely critical in taking steps to restore choice, flexibility and innovation to the nation’s health care markets. The Chamber looks forward to working with the House and Senate to refine and advance these and other important reform proposals."[32]
- The Wall Street Journal editorial board - "The American Health Care Act would be the most consequential GOP social-policy reform since the welfare overhaul of 1996. Not only does the bill repair the failures of the Affordable Care Act, it starts to correct many of the government-created dysfunctions that have bedeviled U.S. health care for decades."[33]
Oppose
- Heritage Action - Michael Needham, chief executive of Heritage Action, said, "To the extent that they’re doing something else with this plan other than full repeal, the concerns that conservatives in the House are expressing are completely valid."[34]
- Freedom Partners: Nathan Nascimento, Freedom Partners’ vice president of policy, said, "Fully repealing Obamacare needs to be Congress’ top priority, but raising taxes to create a new entitlement in its place keeps Washington at the center of our health-care system and leaves Obamacare’s crumbling foundation largely intact."[34]
- American Medical Association - Dr. Andrew Gurman, president of the American Medical Association (AMA), wrote in a letter to Congress, “As drafted, the AHCA would result in millions of Americans losing coverage and benefits. By replacing income-based premium subsidies with age-based tax credits, the AHCA will also make coverage more expensive — if not out of reach — for poor and sick Americans. For these reasons, the AMA cannot support the AHCA as it is currently written. ... We encourage you to ensure that low and moderate income Americans will be able to secure affordable and adequate coverage and that Medicaid, [Children's Health Insurance Program], and other safety net programs are maintained and adequately funded. And critically, we urge you to do all that is possible to ensure that those who are currently covered do not become uninsured.”[35]
- The American Hospital Association - Richard Pollack, the president and CEO of the American Hospital Association, wrote in a letter to House Republicans, “We ask Congress to protect our patients, and find ways to maintain coverage for as many Americans as possible. We look forward to continuing to work with the Congress and the Administration on [Affordable Care Act] ACA reform, but we cannot support The American Health Care Act in its current form. If coverage is not maintained at the current level, those resources need to be returned to hospitals and health systems in order to provide services to what will likely be an increased number of uninsured Americans. The expanded use of waivers with appropriate safeguards can be very effective in allowing state flexibility to foster creative approaches and can improve the program more effectively than through imposing per-capita caps. We urge that Congress should wait until an estimate is available before proceeding with a formal consideration. ... We believe that any changes to the [Affordable Care Act] must be guided by ensuring that we continue to provide health care coverage for the tens of millions of Americans who have benefitted from the law. ... We are pleased that so many in Congress also recognize the need to preserve patient coverage. ... We believe the legislation needs to be reviewed through this lens, and carefully evaluated regarding its impact on both individuals and the ability of hospitals and health systems which are the backbone of the nation's health care safety net in terms of our ability to care for all of those who walk through our doors."[36]
- America’s Essential Hospitals - Dr. Bruce Siegel, president and chief executive of AEH, said in the letter, “America’s Essential Hospitals cannot support the legislation to be considered by the committee."[37]
- America’s Health Insurance Plans[37]
- The Cato Institute’s Michael Cannon - Cannon called it “a train wreck waiting to happen. ... It is remarkable that they’ve produced a bill that is so out of touch with ACA opponents. The first rule in these situations is you want to dance with the gal that brung ya. You don’t want to walk away from your base.”[38]
News feed
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See also
Footnotes
- ↑ 1.0 1.1 Reuters, "U.S. House passes healthcare bill in big win for Trump," May 4, 2017
- ↑ Reuters, "U.S. House nears cliffhanger vote on healthcare law," May 4, 2017
- ↑ Reuters, "Live: U.S. Politics," May 4, 2017
- ↑ The New York Times, "The Parliamentary Tactic That Could Obliterate Obamacare," January 4, 2017
- ↑ Politico, "GOP unveils Obamacare replacement amid sharp party divide," March 6, 2017
- ↑ The U.S. House of Representatives House Committee on Rules - Democrats, "Summary of the Byrd Rule," accessed May 4, 2017
- ↑ CNN, "Essential Health Benefits and why they matter," accessed March 24, 2017
- ↑ CNN, "Rand Paul: Bring Pence to Senate to repeal Obamacare," March 22, 2017
- ↑ The Hill, "House cancels ObamaCare repeal vote as GOP defections mount," accessed March 24, 2017
- ↑ Politico, "Thursday vote on health care bill canceled," accessed March 23, 2017
- ↑ Politico, "White House pressures GOP leaders on Obamacare showdown next week," April 20, 2017
- ↑ CNBC, "Republicans have a new plan to repeal Obamacare — and here it is," April 20, 2017
- ↑ Congress.gov, "H.Res.254 - Providing for further consideration of the bill (H.R. 1628) to provide for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017," accessed April 26, 2017
- ↑ Freedom Caucus endorses revised ObamaCare repeal-and-replace bill," April 26, 2017
- ↑ The New York Times, "$8 Billion Deal Gives Crucial Momentum to G.O.P. Health Bill," May 3, 2017
- ↑ The Hill, "Key GOP reps will back ObamaCare repeal bill with new amendment," May 3, 2017
- ↑ 17.00 17.01 17.02 17.03 17.04 17.05 17.06 17.07 17.08 17.09 17.10 House Energy and Commerce Committee, "Budget Reconciliation Legislative Recommendations Relating to Repeal and Replace of the Patient Protection and Affordable Care Act," accessed March 7, 2017
- ↑ 18.0 18.1 The New York Times, "$8 Billion Deal Gives Crucial Momentum to G.O.P. Health Bill," May 3, 2017
- ↑ House Committee on Rules, "Amendment to HR 1628 As Reported - April 6," accessed May 15, 2017
- ↑ The Hill, "Key GOP reps will back ObamaCare repeal bill with new amendment," May 3, 2017
- ↑ Politico, "White House plans Obamacare showdown next week," April 20, 2017
- ↑ 22.0 22.1 22.2 NPR, "MacArthur Amendment to the American Health Care Act," April 13, 2017
- ↑ National Association of Insurance Commissioners, "Patient Protection and Affordable Care Act of 2009: Health Insurance Exchanges," April 20, 2010
- ↑ House Committee on Rules, "Amendment #33 offered by the Hon. Thomas MacArthur," accessed May 17, 2017
- ↑ The Hill, "Live coverage: Trump, GOP scramble for ObamaCare votes," March 24, 2017
- ↑ Washington Post, "This is why Obamacare is canceling some people's insurance plans," October 29, 2013
- ↑ 27.0 27.1 U.S. House of Representatives, "Policy Amendment to the Manager's Amendment (Policy Changes) to H.R. 1628," accessed March 24, 2017
- ↑ Politico, "GOP leaders pile on sweeteners to sell Obamacare repeal," March 20, 2017
- ↑ Congressional Budget Office, "Congressional Budget Office Cost Estimate: American Health Care Act of 2017," May 24, 2017
- ↑ CBO.gov, "Congressional Budget Office Cost Estimate: American Health Care Act," accessed March 14, 2017
- ↑ The Wall Street Journal, "Ads Push Conservatives to Get on Board With GOP Health Plan," accessed March 9, 2017
- ↑ USChamber.com, "U.S. Chamber Optimistic about House GOP Health Reform Proposal," accessed March 9, 2017
- ↑ The Wall Street Journal, "A Historic Health-Care Moment," accessed March 9, 2017
- ↑ 34.0 34.1 34.2 The Wall Street Journal, "Conservative Groups Jeopardize GOP Plan to Repeal Affordable Care Act," accessed March 6, 2017
- ↑ The Hill, "American Medical Association opposes GOP ObamaCare bill," accessed March 8, 2017
- ↑ AHA.org, "Letter to Congress," accessed March 8, 2017
- ↑ 37.0 37.1 The Wall Street Journal, "Opposition Mounts as GOP’s Health Bill Undergoes Review," accessed March 9, 2017
- ↑ Politico, "Ryan disappoints his friends with Obamacare replacement bill," accessed March 8, 2017
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