Burlington County Times

Congressman Tom MacArthur To Vote 'Yes' On GOP Health Care Overhaul

Burlington County Times — March 21, 2017

By David Levinsky, staff writer

The U.S. House of Representatives is expected to vote Thursday on Republican legislation to overhaul health care, and a key New Jersey member says he is now on board.

Congressman Tom MacArthur, R-3rd of Toms River, said Tuesday that because of changes in the legislation agreed to by Republicans leaders and President Donald Trump, he plans to vote in support of the bill, which would undo much of the Obama administration's 7-year-old Affordable Care Act.

The nonpartisan Congressional Budget Office has said the measure would save the federal government about $337 billion over the next decade but may cause millions more Americans to become uninsured.

Key among the changes Republican leaders agreed to Monday was language MacArthur proposed to pave the way for the addition of another $85 billion in tax credits to help older Americans pay for health coverage.

MacArthur previously cited as one of his chief concerns the expected gap between the federal subsidies given to older residents under the ACA and the tax credits promised under the Republican bill.

The second-year congressman also sought assurances that the curbs in the American Health Care Act on the growth of Medicaid, the federal-state insurance program for the disabled and poor, would not take effect before 2020.

Republican leaders also agreed to change some of the fine print involving the Medicaid cap to allow payments for elderly and disabled residents to increase 1 percent above the medical consumer price index. The change, which is expected to cost the federal government about $60 billion, should help states maintain crucial benefits for the most vulnerable, MacArthur said.

"We're getting what I think is a pretty dramatic improvement," he said Tuesday following a meeting with Trump and Vice President Mike Pence. "These things, for me, were enough for me to overcome the things I still don't like about the bill. But it's a compromise."

"I had to make a decision once it became clear (the legislation) was moving forward whether I was going to try to make some constructive changes or be an obstructionist. And I don't think Congress needs another obstructionist."

MacArthur's support could be crucial in the final vote count, which is expected to be close. No Democrats are expected to support the legislation, so the GOP can lose no more than 21 of its own members to pass the measure and send it to the Senate.

MacArthur is also co-chairman of the Tuesday Group, a caucus of centrist Republican members that could be key in deciding the measure's fate. He drew attention earlier this year by voting "no" on a House budget resolution to make it easier for repeal legislation to make it to the president.

As proposed, the repeal legislation would do away with most of the Affordable Care Act's taxes and fines, while maintaining some of its popular components, such as the prohibition against insurers refusing coverage for people with pre-existing conditions and the requirement that parents be allowed to keep adult children on their policies until they turn 26.

But while the bill would eliminate the fines on people who don't carry insurance as well as the law's minimum requirement for health plans, it also eliminates the income-based tax subsidies the ACA gave to millions of Americans to buy insurance, replacing them with age-based tax credits that aren't as generous to some.

MacArthur and some other moderates sought credits for older Americans to be increased. The legislation now calls for credits that would start at $2,000 for individuals under age 30 and rise to $4,000 for people over 60.

Critics have complained that those credits are far less than the ACA's subsidies, especially for people in their 50s or early 60s, who, under the proposed bill, could also be charged significantly more for insurance.

The House amendments do not specifically increase the tax credits. Instead, Republican leaders said language has been added that would give the Senate the ability to expand assistance for people between 50 and 64.

About $85 billion is expected to go toward assisting that population, but it's not immediately clear if that money will be directed to expanding the tax credits.

Opponents of the legislation said there are no guarantees the money will be used to expand tax credits. They also doubt the money would be enough to close the gap between the ACA subsidies and the GOP tax credits.

"The $85 billion is a slush fund. It's not structured and it's not defined how it will be used," U.S. Rep. Frank Pallone, D-6th of Long Branch, said Tuesday. "It's really just throwing money to attract votes."

MacArthur said Trump, U.S. Secretary of Health and Human Services Tom Price and Senate Majority Leader Mitch McConnell have voiced support for increasing aid for the age group. The additional money should result in a $2,000 increase in the maximum available tax credits for that population, he said.

The GOP bill also calls for big changes in how the federal government funds Medicaid. Beginning in 2020, federal payments to Medicaid would be capped, and states that continue to add new Medicaid recipients will no longer receive additional federal funds called for under the ACA's Medicaid expansion.

New Jersey insured over 300,000 more residents through the optional expansion, amounting to about $3 billion in additional federal aid.

MacArthur sought assurances that the bill wouldn't be amended so that the program is capped before 2020, something many conservative GOP members had pushed for in order to boost savings.

"It gives people and states the chance to get ready," he said, adding that it also makes sure there's no gap in coverage for people who might qualify for Medicaid before the tax credits become available.

The new amendments would allow states to create work requirements for Medicaid recipients and choose to accept federal funding as a block grant rather than a capped per-person sum. Also, more states would not be permitted to join the 31 that have already opted to expand Medicaid under the ACA.

Opponents said the cap on federal Medicaid payments amounts to a fundamental change in the program that will place the burden on states to pick up the tab for rising health care costs of people enrolled in the program.

They predicted that states won't have the money to keep pace with health care cost inflation and will be forced to reduce benefits or cut enrollment.

New Jersey Policy Perspective, a left-leaning think tank, predicted that the GOP bill would cause a half-million state residents to become uninsured, including about 34,000 in MacArthur's 3rd District.

"We'll have more people uninsured than we had before the Affordable Care Act," said Ray Castro, an analyst with the think tank.

AARP leaders also said the organization remains strongly opposed to the legislation and planned to inform its members of how individual lawmakers vote on Thursday.

Brian McGuire, associate state director of AARP New Jersey, said he was disappointed to learn that MacArthur planned to support the legislation. He said he was still hopeful the House vote might fail, and he was confident the Senate would propose something "drastically different."

Maura Collinsgru, health care program director for the progressive group New Jersey Citizen Action, said activists would continue to press MacArthur to change his position.

"We have 48 hours to change that, and we'll be working hard," she said.

MacArthur said that the legislation was only a start and that more needed to be done to reduce health care expenses for all Americans.

"We've started a process of reforming health care in America that was really unsustainable," he said. "What we're creating is sustainable delivery of health care that gets back to patients choosing the health care they want, with some government support."

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