WASHINGTON — House Republicans unveiled their long-awaited plan to repeal and replace the Affordable Care Act, scrapping the mandate that nearly all Americans have health insurance and replacing it with a system of tax credits aimed at enticing Americans to purchase health care on the open market.
The bill's unveiling set the stage for a bitter and consequential debate over the possible dismantling of the most significant health care law in a half-century. Republicans hope to undo major parts of President Barack Obama's signature domestic achievement, including income-based tax credits that help millions of Americans afford insurance, taxes on people with high incomes and the penalty for people who do not buy health coverage.
Under the Republican plan, the income-based tax credits would be replaced with credits that would rise with age. In a late change, the plan was also expected to include language limiting who is eligible for the tax credits, so that affluent Americans would not receive them.
The release of the legislation is a key step toward fulfilling a campaign pledge — repeal and replace — that has animated Republicans since the Affordable Care Act passed in 2010. But even after President Donald Trump's election in November, it is far from certain that Republican lawmakers will be able to get on the same page and repeal the health measure.
On Monday, four Republican senators — Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska — signed a letter saying a House draft that they had reviewed did not adequately protect people in states like theirs that have expanded Medicaid under the Affordable Care Act. Three conservative Republicans in the Senate — Mike Lee of Utah, Rand Paul of Kentucky and Ted Cruz of Texas — had expressed reservations about the House's approach. In combination, the conservatives and moderates have more than enough votes to bring it down in the Senate.
While Republicans have argued over how to proceed, Trump has expressed only vague goals for how to repeal the Affordable Care Act and improve the nation's health care system. On Capitol Hill, lawmakers and their aides are waiting to see whether he uses his platform, Twitter account and all, to press reluctant Republicans to get behind the House plan.
The House Republican plan is expected to gradually end the expansion of Medicaid, which has provided coverage to more than 10 million people in 31 states.