Republicans on Monday took a step closer towards delivering on Donald Trump’s pledge to scrap Obamacare, by unveiling a long-awaited plan to repeal the healthcare reforms that is set to trigger fierce debate in Congress.
The draft legislation, which would roll back many of the core tenets of Barack Obama’s government-led healthcare legacy, was released by Republican lawmakers who have struggled to bridge internecine divisions as they craft a bill for the president.
The legislation will provide a starting point for bartering among Republicans, most notably in the Senate, but it is far from certain to win enough GOP support to pass Congress and reach Mr Trump’s desk.
The plan from House Republicans abolishes Mr Obama’s requirement for every American to buy health insurance or pay a penalty, replacing it with a new system of tax credits designed to encourage people to buy affordable insurance.
Unlike subsidies offered under Obamacare, those tax credits would be determined by the individual consumer’s age instead of their income.
Mr Trump and congressional Republicans have targeted the repeal and replacement of Obamacare as their first legislative priority, but their efforts have become bogged down in recent weeks, freezing progress on other fronts such as tax reform.
The party is seeking to repeal Obamacare using a budget process that would enable them to proceed without any Democratic support, but it requires near total Republican unity.
The House plan would also cut back the expansion of the Medicaid health programme for low-income Americans that was part of Mr Obama’s signature healthcare programme, a proposal that is anathema to some Republican senators.
On Monday four Republican senators — Rob Portman of Ohio; Shelley Moore Capito of West Virginia; Cory Gardner of Colorado*; and Lisa Murkowski of Alaska — sent a letter to Senate leader Mitch McConnell urging him to reject any bill that cut back Medicaid.
“We believe Medicaid needs to be reformed, but reform should not come at the cost of disruption in access to healthcare for our country’s most vulnerable and sickest individuals,” they wrote.
“Any changes made to how Medicaid is financed through the state and federal governments should be coupled with significant new flexibility.”
Under the House repeal bill, Mr Obama’s Medicaid expansion programme would continue only until 2020.
The bill retained two popular elements of the Obamacare reforms that Mr Trump said he wants to keep — the ability for young adults to stay on their parents’ insurance plans and a ban on insurers denying coverage to people who are already unwell.
Democrats have already launched a vocal attack on the plan, which they say is likely to leave more Americans uninsured, particularly low-income individuals who had benefited from the expansion of Medicaid.
Cory Gardner is a senator for Colorado. This article has been amended from earlier publication.
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