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House GOP Weighs Options for New Approach to Health Law

House leaders will meet to discuss options on Thursday, just one day after the Trump administration issued its first regulation on the Affordable Care Act

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    House Speaker Paul Ryan (R-WI, center), walks away from a news conference on February 14, 2017, in Washington, D.C. Ryan fielded questions on the resignation of National Security Advisor Michael Flynn and the repeal of the Affordable Care Act. (Photo by Mark Wilson/Getty Images)

    With the Republican drive to craft a new health care plan sputtering, House GOP leaders are offering options to rank-and-file lawmakers for replacing President Barack Obama's health care law with a conservative approach dominated by tax breaks and a transition away from today's Medicaid program.

    House Speaker Paul Ryan, R-Wis., and other House leaders planned to discuss details of their plans with lawmakers Thursday and gauge their receptiveness. The briefing was coming hours before a weeklong recess sends Congress home to energized voters — mostly Democrats — who have recently crammed town hall meetings to complain noisily about GOP efforts to repeal Obama's statute. Lawmakers are eager to have something to show constituents.

    "This is complicated work. We're not going to rush it," said Rep. Greg Walden, R-Ore., chairman of the House Energy and Commerce Committee, one of the panels helping craft the legislation.

    Walden said by the end of March, his committee would start writing its part of the measure voiding much of Obama's law and substituting GOP programs. That's the most recent of several self-imposed deadlines that President Donald Trump and GOP leaders have set, but until now failed to meet, for reconfiguring the nation's health care system.

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    With Senate Republicans straining to coalesce around plans, new Health and Human Services Secretary Tom Price met privately with GOP senators Wednesday, but participants said no specifics were discussed. Sen. Roger Wicker, R-Miss., said lawmakers and the White House are trying to decide who should release a plan to replace Obama's law first — the White House or Congress.

    Asked to characterize those discussions, Wicker said: "You go first. No, you go first."

    Thursday's House GOP meeting was coming a day after the Trump administration took regulatory steps aimed at curbing Obama's law. These included making it harder for people to sign up for coverage outside of open enrollment periods and eased IRS enforcement of fines for people who don't buy insurance.

    Lawmakers, aides and lobbyists who described House leaders' plans said they strongly resembled a broad outline that Ryan released last summer as a campaign document for Republican candidates to tout to voters. Most spoke on condition of anonymity because the proposals hadn't been released publicly.

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    In a significant departure from Ryan's summertime proposal, the options being discussed Thursday will not address Medicare, which helps pay for guaranteed health care for the elderly. Ryan has backed reshaping it into a voucher-like program that people could use to buy coverage, but Trump has said he doesn't want to revamp Medicare.

    Under the ideas being discussed Thursday, the tax penalties that Obama's law imposed on people who don't buy insurance would be killed. Also eliminated would be the subsidies the government provides most people who buy coverage on the online marketplaces the statute established.

    Instead, tax-favored health savings accounts would be expanded and refundable tax credits, paid in advance, would be available to millions of Americans. With refundable credits, even people with low or no income would receive checks from the IRS.

    On one of the most contentious issues, Republicans would gradually change Medicaid, which helps poor and disabled people afford health care. While it now guarantees coverage for everyone who qualifies, the options being discussed include giving money to the states generally based on the number of Medicaid beneficiaries with adjustments for the type of care they need, and states would have more power to decide who qualifies for coverage.

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    Republicans would provide extra money to both the 31 states that expanded Medicaid coverage under Obama's law and the 19 others — mostly dominated by the GOP — that refused to do so. That disbursement of funds has caused major rifts between GOP-led states that increased their Medicaid coverage and don't want to lose that money, and states that didn't expand but want extra funds now.

    The GOP plans also include federal contributions to states for high risk pools, where people with illnesses that are expensive to cover could purchase policies.

    And because of many Republicans' opposition to abortion, the retrofitted medical system would block Planned Parenthood from receiving federal payments, which comprise nearly half its annual $1.1 billion budget.

    Democrats defending Obama's law oppose all of the GOP ideas, saying they'd leave many people unable to afford health coverage.

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