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Tierney Sneed

Tierney Sneed is a reporter for Talking Points Memo. She previously worked for U.S. News and World Report. She grew up in Florida and attended Georgetown University.

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Republicans pushing for passage of GOP leadership's Obamacare replacement bill were able to head off a major intra-party fight over how the legislation handled Medicaid expansion -- at least for now, as supporters of phasing out expansion even sooner than the current bill withdrew an amendment to that effect Thursday.

Under the leadership's bill, the American Health Care Act, Medicaid expansion would be allowed to continue until the end of 2019, at which point enrollment would be frozen, with the expectation that the program would wither away on its own. Conservatives are pushing for that deadline to come sooner, and Wednesday, during the mark up of the AHCA in the Energy and Commerce Committee, Rep. Joe Barton (R-TX) introduced an amendment that would have frozen the program at the end of 2017. By Thursday morning, as criticisms of the idea from expansion state Republicans began to rack up, the amendment had been withdrawn and the bill passed by the committee with its expansion provisions as is.

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An analysis by the Kaiser Family Foundation of the leading Republican plan to repeal and replace Obamacare shows that the GOP-proposed tax credits will become even more meager when compared to the Affordable Care Act over time.

The analysis predicts that under the GOP bill, titled the American Health Care Act, the tax credits the average individual would receive will be 41 percent lower than what they would had gotten under Obamacare in 2022 and 44 percent lower in 2027. The trend is driven by the metric the Republican proposal uses to increase the credits: inflation plus one percentage point. Health care costs tend to rise faster than inflation, and faster than inflation plus one percentage point.

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At the core of the Republican sales pitch for their Obamacare replacement is the the promise of lower premiums. The problem is they don’t have much in their bill to point to that will, without a doubt, fulfill that promise.

It's not the cure to the Obamacare ailment that conservatives were looking for.

“It doesn’t change an awful lot,” said Joe Antos, a health care policy expert at the right-leaning American Enterprise Institute.

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A major trade organization for the insurance industry raised a number of a concerns with Republicans' health care legislation in a letter to GOP leaders surfaced by Bloomberg Wednesday.

The letter, from Marilyn Tavenner, the CEO of America's Health Insurance Plans, called for more generous tax credits for consumers to use on the individual market and was skeptical with the bill's proposal to transform Medicaid into a block grant program with a per capita cap.

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Almost none of the Obamacare taxes survive in the repeal legislation that the GOP congressional leadership is pushing. But the one Obamacare tax that Republicans do retain -- though it is delayed for almost a decade -- is a surprising candidate. The legislation includes an implementation in 2025 of the widely loathed Cadillac tax, which imposes a 40 percent levy on the most generous of employer health insurance plans.

House Speaker Paul Ryan’s “Better Way” agenda called the Cadillac tax “controversial,” while the the head of the conservative political organization Heritage Action once described it as a “political nightmare of epic proportions.”

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A major hospital group that represents nearly 5,000 hospitals came out against the Republican Obamacare repeal legislation introduced this week.

Richard Pollack, CEO and president of the American Hospital Association, sent a letter Tuesday to members of Congress raising concerns about the the bill's overhaul of Medicaid and other proposals included in the legislation, called the The American Health Care Act.

"We look forward to continuing to work with the Congress and the Administration on ACA reform, but we cannot support The American Health Care Act in its current form," Pollack said.

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Alice Ollstein contributed reporting.


House Speaker Paul Ryan (R-WI) is not in the mood to negotiate the Obamacare repeal bill – and he doesn't want you to get the idea that the vice president is either.

Ryan pushed back at the idea that Vice President Mike Pence had told conservative hardliners that the Obamacare repeal bill unveiled this week was open to negotiations, arguing that what Pence meant is that Republicans are at the beginning of a process that will also include administrative changes to the law and separate health care reform bills down the road.

“It’s not that this is open for negotiations," Ryan said Tuesday at a press conference to tout the legislation, the American Health Care Act. Pence had met with Republicans on both sides of the chamber Tuesday, including the House hardliners resisting the bill.

"What Mike is trying to describe is we envision three phases,” Ryan said, referring to a process that will start with the American Health Care Act, incorporate regulatory changes made by Health and Humans Secretary Tom Price and eventually include standalone health care bills that will need Democratic support.

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Flanked by the GOP Senate leadership team, Vice President Mike Pence on Tuesday delivered an implicit message to those conservatives who are resisting House Republicans' newly-unveiled Obamacare repeal bill.

"The President and I believe that the American Health Care Act is the framework for reform," Pence told reporters after meeting with the Senate GOP, referring to the controversial legislation.

"We're certainly open to improvements and to recommendations in the legislative process, but this is the bill and the President supports the American Health Act," Pence said.

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Conservative groups railed against the Obamacare repeal legislation released by House leadership this week, taking issue with the refundable tax credits the bill offers, as well as a continuous coverage requirement which critics likened to the Affordable Care Act's individual mandate.

A statement Tuesday from Jason Pye, director of public policy and legislative affairs at FreedomWorks, labeled the GOP bill "ObamaCare-lite." Michael Needham, the CEO of Heritage Action, argued the legislation "not only accepts the flawed progressive premises of Obamacare but expands upon them." The staff of the Republican Study Committee, which boasts 170 members in the House, said in a memo obtained by Bloomberg that the tax credits amounted to "a Republican welfare entitlement.”

Meanwhile, the House Freedom Caucus, a group of hardliners known to derail Republican agenda items, is planning its own press conference on the legislation later Tuesday afternoon. The House hardliners will be joined by Sens. Mike Lee (R-UT) and Sen. Rand Paul (R-KY), who has introduced his own Obamacare replacement legislation that has the backing of conservatives.

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After seven years of failing to coalesce around an Obamacare replacement bill, GOP congressional leaders unveiled Monday evening legislation to dismantle the Affordable Care Act and replace it with a program that includes enough government assistance to alienate conservatives, who have called some of the proposals "Obamacare-lite," while scaling back other coverage gains made under the ACA that could make moderate Republicans uncomfortable.

Here are 5 points on how to assess the legislation and the questions that remain:

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