House leaders are pressing ahead with their plan to repeal and replace the Affordable Care Act, despite mounting opposition from conservatives within their own party, Democrats and a number of prominent health-care industry groups.

House leaders released their replacement bill March 6, and the House Ways and Means Committee voted 23-16 early this morning to advance the bill after roughly 18 hours of debate. Ways and Means Committee Chairman Kevin Brady (R-TX) cited President Trump’s support of the bill this week as a sign that Republicans are ready to unite and deliver on their promises to end Obamacare and find a better health care solution for those Americans who aren’t already covered through employer-provided insurance.

“Ways and Means Republicans just passed legislation that will help Americans finally have access to affordable health care,” Brady said. “This legislation reflects President Trump’s strong commitment to improving health care for all Americans. I sincerely thank my colleagues for their hard work and commitment to delivering on the President’s promise.”

The Energy and Commerce Committee also passed the bill earlier today. The bill, called the American Health Care Act (AHCA), replaces ACA subsidies with new refundable, age-based tax credits for those without employer-provided health insurance. The tax credits would begin phasing out for individuals with incomes above $75,000 and families earning more than $150,000. The plan would also freeze Medicaid expansion in 2020 and phase it out over time. Nationally, more than 11 million people are covered by Medicaid through the expansion under the ACA.

The bill would eliminate the individual mandate but would attempt to encourage people to maintain coverage by allowing insurers to impose a surcharge of 30 percent on those who have gaps in their coverage. Nearly all of the ACA’s taxes would be eliminated with the exception of the “Cadillac” tax on high-cost health plans – a tax that ASAE and many other business groups opposed. The House bill would allow the Cadillac tax to take effect in 2025 as a means of trying to ensure that the legislation does not add to the deficit after 10 years. It would also strip funding for Planned Parenthood.

Democrats, as expected, are united against the bill, which they point out has not even been scored yet by the Congressional Budget Office (CBO). “Transparency is clearly lacking in this process,” said Ways and Means Ranking Member Richard Neal (D-MA). “The American people deserve better from their representatives. Also, to consider a bill of this magnitude without a CBO score is not only puzzling and concerning, but also irresponsible.”

Conservatives also dislike the bill, particularly the new tax credits which they view as another entitlement. The Freedom Caucus, a block of roughly 30 hard-line conservatives in the House, has been critical of key elements of the plan as well as the potential cost. Over in the Senate, the bill is taking heat from conservatives like Sen. Ted Cruz (R-TX) and Rand Paul (R-KY) and more moderate Republicans who are concerned about changes in the bill for states that accepted Medicaid expansion under the ACA.

House leaders have been trying to sell the plan to business groups this week but encountered another backlash when major associations like AARP, the American Medical Association and the American Hospital Association came out squarely against the bill.

“While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations,” said James Madara, CEO of the AMA, in a letter to Ways and Means and Energy and Commerce Committee members.

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