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| States Could Make Work a Medicaid Requirement Under G.O.P. Deal | |
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| WASHINGTON — President Trump and conservative lawmakers in the House agreed on Friday to allow states to impose work requirements on able-bodied Medicaid recipients and to accept federal Medicaid funds as one annual lump-sum block grant, two major concessions to balking hard-liners as they try to rally support for legislation to repeal the Affordable Care Act. | WASHINGTON — President Trump and conservative lawmakers in the House agreed on Friday to allow states to impose work requirements on able-bodied Medicaid recipients and to accept federal Medicaid funds as one annual lump-sum block grant, two major concessions to balking hard-liners as they try to rally support for legislation to repeal the Affordable Care Act. |
| The agreement on the revisions came as Republican leaders said the full House would vote next week on the bill to undo President Barack Obama’s signature domestic achievement. | The agreement on the revisions came as Republican leaders said the full House would vote next week on the bill to undo President Barack Obama’s signature domestic achievement. |
| “I want everyone to know, I’m 100 percent behind this,” Mr. Trump said at the White House, where he met with House members in the conservative Republican Study Committee. | “I want everyone to know, I’m 100 percent behind this,” Mr. Trump said at the White House, where he met with House members in the conservative Republican Study Committee. |
| The concessions are significant, at least symbolically, and they are politically risky. The Obama administration refused to allow work requirements, saying they were not consistent with the goals of Medicaid, the health insurance program for low-income people. Several Republican governors have expressed interest in requiring healthy adults to have a job before receiving Medicaid. | The concessions are significant, at least symbolically, and they are politically risky. The Obama administration refused to allow work requirements, saying they were not consistent with the goals of Medicaid, the health insurance program for low-income people. Several Republican governors have expressed interest in requiring healthy adults to have a job before receiving Medicaid. |
| On block grants, the initial House bill would end Medicaid as an open-ended entitlement to health care, replacing that with an allotment to the states for each Medicaid beneficiary. If, instead, states accepted lump-sum payouts, they would gain more freedom to administer the program and define eligibility and benefits — but new enrollees would be taking money from a fixed pot. It is not clear which — if any — states would accept that option. | On block grants, the initial House bill would end Medicaid as an open-ended entitlement to health care, replacing that with an allotment to the states for each Medicaid beneficiary. If, instead, states accepted lump-sum payouts, they would gain more freedom to administer the program and define eligibility and benefits — but new enrollees would be taking money from a fixed pot. It is not clear which — if any — states would accept that option. |
| The changes in Medicaid provisions of the bill could help win over conservative House members who have expressed concern or outright opposition to the bill for multiple reasons. | The changes in Medicaid provisions of the bill could help win over conservative House members who have expressed concern or outright opposition to the bill for multiple reasons. |
| “On balance and with the changes we agreed to in the bill’s final text, I can vote for it,” Representative Mark Walker of North Carolina, chairman of the Republican Study Committee, said after the meeting in the Oval Office. | “On balance and with the changes we agreed to in the bill’s final text, I can vote for it,” Representative Mark Walker of North Carolina, chairman of the Republican Study Committee, said after the meeting in the Oval Office. |
| But changing the bill to win over conservatives risks alienating more moderate members of the House and Senate who worry that the measure could cause millions of people to lose health coverage. The Republican governors of four states — Arkansas, Michigan, Nevada and Ohio, all of which expanded Medicaid under the Affordable Care Act — drafted a letter this week formally rejecting the House bill as written. | But changing the bill to win over conservatives risks alienating more moderate members of the House and Senate who worry that the measure could cause millions of people to lose health coverage. The Republican governors of four states — Arkansas, Michigan, Nevada and Ohio, all of which expanded Medicaid under the Affordable Care Act — drafted a letter this week formally rejecting the House bill as written. |
| House Republican moderates may be especially loath to take a difficult political vote for the measure if they are convinced it would die in the Senate. | House Republican moderates may be especially loath to take a difficult political vote for the measure if they are convinced it would die in the Senate. |
| “If I hear one more senator tell me that this bill is dead on arrival, I think my head is going to explode,” said Representative Charlie Dent, a moderate Republican from Pennsylvania. “That’s certainly not something many members of the House find very appetizing — voting for something that will go nowhere in the Senate.” | “If I hear one more senator tell me that this bill is dead on arrival, I think my head is going to explode,” said Representative Charlie Dent, a moderate Republican from Pennsylvania. “That’s certainly not something many members of the House find very appetizing — voting for something that will go nowhere in the Senate.” |
| The worries among lawmakers about people losing coverage intensified this week after the nonpartisan Congressional Budget Office estimated that, under the House bill, the number of people without health insurance would rise by 14 million next year and by 24 million by 2024. | The worries among lawmakers about people losing coverage intensified this week after the nonpartisan Congressional Budget Office estimated that, under the House bill, the number of people without health insurance would rise by 14 million next year and by 24 million by 2024. |
| Another likely change, Republicans said, would be to restructure the income tax credits offered under the bill to help people buy private health insurance. | Another likely change, Republicans said, would be to restructure the income tax credits offered under the bill to help people buy private health insurance. |
| Republican lawmakers had expressed concern that the tax credits, as originally devised by House party leaders, were insufficient and could have produced huge increases in premiums for some people age 50 to 64. | Republican lawmakers had expressed concern that the tax credits, as originally devised by House party leaders, were insufficient and could have produced huge increases in premiums for some people age 50 to 64. |
| Some 20 million people have gained coverage under the health care law, which was adopted in 2010 without any Republican votes. | Some 20 million people have gained coverage under the health care law, which was adopted in 2010 without any Republican votes. |
| The bill to undo the law is technically a budget bill, and it is being considered under special procedures that allow approval by a simple majority in the Senate, neutralizing the threat of a filibuster. | The bill to undo the law is technically a budget bill, and it is being considered under special procedures that allow approval by a simple majority in the Senate, neutralizing the threat of a filibuster. |