Senate Republicans Mull Tax Amendments to Save GOP Health Bill

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By Colleen Murphy and Laura Davison

A Senate Republican wants to alter the House’s Affordable Care Act-replacement legislation to give low-income people more generous tax credits, after an analysis showed 24 million individuals could lose insurance under the plan.

Sen. John Thune (R-S.D.) said his amendment would make the tax credits more “targeted by age and income,” and could either be added to the House bill or offered once it reaches the Senate. Senate Republicans are looking to restructure the bill to mitigate the harsh estimates the Congressional Budget Office released March 13 and to ensure it can pass the chamber—something they say won’t happen if the existing bill remains unchanged.

“I think there are things we can do to tailor the tax credits that make them more attractive to people and more helpful to people on the lower end, and with a phaseout that is a little less steep than what the House has,” Thune said March 14.

The House bill, introduced March 6, includes a refundable tax credit that increases with age and is capped at individual incomes of $75,000 and joint-filer incomes of $150,000. House leaders hope to pass it before the April recess, but the existence of a refundable credit has already made it a no-go for some House members. The stark estimates from the CBO, with steeply rising premiums in the short term and many losing coverage in the long term, have both moderate and hard-right Republicans pulling on the plan.

The chairmen of the two House committees with jurisdiction over the bill—Kevin Brady (R-Texas) of Ways and Means and Greg Walden (R-Ore.) of Energy and Commerce—met with Senate Republicans March 14 to discuss possible changes to the legislation, Sen. Bill Cassidy (R-La.) told reporters.

Brady and Walden both expressed willingness to give further considerations to changing the tax credits for low-income, older people, he said. Cassidy, who gave individuals the choice to keep their current coverage in his version of an ACA-replacement plan, said the existing tax credits in the bill will be insufficient for those with low incomes.

“I think you have to do something for the less well off,” he said.

Coverage Calculations

A 40-year-old individual earning $26,500 currently pays a net premium of $1,700, which would increase 41 percent to $2,400 under the House bill. That amount would increase more than seven times, to $14,600, for a 64-year-old earning the same amount, according to the CBO.

Sen. Ted Cruz (R-Texas), one of the bill’s staunchest Senate opponents, says lawmakers need to be looking in the other direction. The fact that premiums continue to rise under the House plan is “unacceptable” and no refundable tax credit can fix that, he said.

“That is not the mandate we were elected to fulfill,” he said March 14. “The only way to drive down premiums is to repeal crushing insurance mandates that drive premiums through the roof.”

Cruz said he also believes the bill is open for negotiation, an opinion held by some hard-right House Republicans but disputed by leadership who say the bill is something around which lawmakers must coalesce.

House Speaker Paul D. Ryan (R-Wis.), who cast aspersions on the CBO’s ability to estimate coverage totals in recent days, has said this is just part one of his three-part plan. Eventually, he says, Health and Human Services Secretary Tom Price will make regulatory changes and lawmakers will be able to offer other bill packages to include elements like the ability to purchase insurance across state lines or through association health plans.

To contact the reporters on this story: Colleen Murphy in Washington at and Laura Davison in Washington at

To contact the editor responsible for this story: Meg Shreve at

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