The Trump administration is putting together a plan to scrap the Affordable Health Care Act, the centerpiece of the Republican health care overhaul, to save money on Medicaid.
The plan, called the “Affordable Care Act Replacement,” is being presented as a compromise between Democrats and Republicans to get the two parties on the same page about how to replace Obamacare, according to three people briefed on the matter.
The move is the latest example of the administration’s increasingly desperate attempts to get lawmakers to agree on something it has repeatedly derided as a “federal takeover” of the health care system.
The administration has been lobbying Congress to move swiftly on a repeal of the ACA since January, even as the Senate is expected to pass a repeal-only bill this week.
In a statement, a White House official said the plan “will address the health and safety of Americans, provide more certainty for those with pre-existing conditions, protect those with disabilities, provide relief to hardworking Americans, and restore fairness and affordability to the health insurance market.”
It was not immediately clear if the administration would seek to scrap provisions of the law that would require insurers to cover people with preexisting conditions and require individuals to get insurance or pay a penalty.
It was also unclear how many members of Congress were expected to sign onto the plan.
The Congressional Budget Office has estimated that the Republican replacement would reduce the number of Americans without health insurance by 26 million, according a Kaiser Family Foundation analysis.
The Trump administration has also been pushing Congress to allow states to waive Obamacare requirements that insurers cover people who have preconditions like cancer, asthma, or HIV.
The move could be particularly contentious because of a bill that is currently pending in the House that would make the waiver a federal requirement.
The White House also is pressing for changes to the federal definition of a preexisting condition, according the people briefed.
The proposal will also address the effects of the AffordableCare Act, which the administration has repeatedly slammed as a failure of the president’s vision and visionaries like former President Barack Obama, who have repeatedly insisted it was not.
Trump is expected not to make the changes himself, but has urged lawmakers to pass legislation to help stabilize the insurance market.
A House Republican aide told reporters Thursday that there is “nothing in the legislation” to undo the ACA’s Medicaid expansion.
Under the proposal, the federal government would pay premiums for insurers to provide health coverage to people with incomes up to 138 percent of the federal poverty level, or about $14,660 for a family of four.
The government would also provide an additional $10 billion to expand Medicaid to low-income people.
The plan would also offer states more flexibility in deciding how much they can spend on insurance subsidies and Medicaid, including whether to limit how much people with preexisted conditions can receive subsidies.
The health care law requires insurers to offer coverage to everyone in a state that meets a number of requirements, including income and household size, and to offer insurance to at least 50 percent of people with income up to 400 percent of poverty.
The program covers people with annual incomes up, say, $50,000 or more, but the average premium in the United States is $7,800 a year for individuals and $14 for families of four, according at least two studies.
Insurers would be required to cover everyone with a pre-condition and to cover them at least 90 percent of all of the time.
A major part of the plan would allow insurers to sell policies that cover only certain conditions and exclude certain others, including pre-existed conditions.
The House Republican plan would give states more leeway to set their own health care requirements.
For example, the plan could allow states in which a lot of people are insured to charge higher premiums for people with high-risk pre-conditions.
The Senate would also give states the option of setting their own requirements for insurers, including for pre-insurance, deductibles, co-pays and other expenses, the people said.
The Republican plan could also allow states that allow insurance to lapse or for insurers that refuse to offer plans to sell plans that do not meet the health law’s requirements.
Insurance companies would still have to provide insurance to people who could qualify for Medicaid, the healthcare program for the poor and disabled.
States that are eligible for Medicaid under the ACA would also have to cover residents with preconditions, including HIV and certain other illnesses.