ASSOCIATED PRESS Ricardo Alonso-Zaldivar and Alan Fram
The government says more than 12 million people have signed up for coverage this year under former President Barack Obama’s health care law, even as the Republican-led Congress debates its repeal. The official national figure of 12.2 million does not include an additional 765,000 people signed up under an option in the Obama era law called the Basic Health Plan, which is used by two states, New York and Minnesota. Traditionally, that figure has been reported separately because of differences in the type of health plan provided. But counting those enrollees as well, sign-ups approach 13 million people. “This report is a reminder that while there’s a big debate in Washington about the future of the Affordable Care Act, the law remains in place for now and is covering millions of people,” said Larry Levitt of the nonpartisan Kaiser Family Foundation. The report was issued by the Centers for Medicare and Medicaid Services, which also administers the ACA’s insurance markets. Meanwhile, House Speaker Paul Ryan was stressing that President Donald Trump helped congressional Republicans write their beleaguered health care bill. His comments came as GOP leaders struggled to stem defections from conservatives and moderates just a week before he hopes to push the measure through the House, and days after congressional budget analysts said it would lead to 24 million more uninsured people in a decade. In the Senate, a senior Republican said even if the health bill passes the House, “it wouldn’t pass the Senate.” On a call with state reporters, Sen. Charles Grassley, R-Iowa, said his party has to act, but he’s concerned that middle aged and older adults will have to pay more under the House bill. House GOP leaders met with Senate counterparts recently and “they got a clear message from Senate Republicans that there had to be changes,” said Grassley. The GOP bill — the American Health Care Act— would repeal major elements of Obama’s law, cap future federal spending on Medicaid for low-income people, and reverse tax increases on wealthy Americans used to finance coverage expansion. Conservatives say the bill is an inadequately weak repeal of “Obamacare.” Party moderates say it will push too many constituents off coverage, including Obama’s expansion of Medicaid for more low-earning people and others who’ve bought insurance — often with federal subsidies — on government-run online marketplaces. The latest government numbers on sign-ups fell short of the Obama administration’s target of 13.8 million for 2017. Moreover, they represent initial enrollment, and there’s usually signi cant attrition over the course of a year. Nonetheless, experts said the report undercuts Republican assertions that the health law’s insurance markets are teetering on the verge of collapse. The market “remains fairly stable in 2017 compared to previous years,” said Caroline Pearson of the consulting firm Avalere Health. The report also underscored the importance of the ACA’s financial assistance, a combination of tax credits to help pay premiums and reduced cost sharing for people with low incomes. Even though list price premiums for a standard “silver” plan went up by more than 20 percent this year, the average premium paid by HealthCare.gov customers after receiving their tax credit only went up by $1 this year, the report said. HealthCare.gov is the federal online insurance market serving 39 states; the remaining states run their own websites. Nationally, more than 8 in 10 enrollees were eligible for income based tax credits to help pay their premiums, and nearly 6 in 10 were eligible for additional assistance with out-of-pocket costs like deductibles and co-payments, the report said. Although the Republican bill would also provide tax credits, they would not be designed to keep pace with rising premiums. And the GOP would eliminate the extra help for out-of-pocket costs, but states would be able to set up such programs of their own. “The markets continue to be dominated by enrollees receiving subsidies,” said Pearson. “Without those subsidies, most enrollees are likely to drop out of the market, since they would not be able to afford coverage.” The enrollment numbers land in the middle of a legislative debate already roiled by a Congressional Budget Office report that forecast coverage losses and rising premiums for older adults. Speaking Wednesday on Fox Business Network, Ryan, R-Wis., said he’s open to “improvements and refinements” of the Republican bill, but said there are limits. “The major components are staying intact because this is something we wrote with President Trump,” Ryan said. “This is something we wrote with the Senate committees.” Furthering the GOP push to round up votes, Vice President Mike Pence was meeting at the Capitol with a large group of conservatives. House Republicans were holding an early evening closed-door meeting at which leaders were hoping to firm up support. The House Budget Committee, whose membership includes several conservative mavericks, was expected to sign off on the measure Thursday in what could be a close vote.
AP writer David Pitt in Des Moines contributed.