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Republican U.S. House Representative Liz Cheney looks out into the audience during a U.S. House debate Oct. 20, 2016, at Casper College in Casper, Wyo. Jenna VonHofe, Casper Star-Tribune via AP

CHEYENNE – As the U.S. House of Representatives prepares to vote on replacing the Affordable Care Act, Wyoming’s sole representative in the chamber said she’s feeling confident in the bill.

The House proposal – known as the American Health Care Act – would be an initial step in dismantling the Affordable Care Act, also known as Obamacare. Health coverage would be affected for millions of Americans, rolling back taxes, coverage mandates and overhauling Medicaid.

Proponents are touting a federal deficit reduction in the billions and potentially lower premiums in coming years. Those opposed say it would leave millions without coverage, hurting the most economically vulnerable.

A House vote is scheduled for Thursday. In the meantime, Republicans are attempting to make adjustments its supporters hope will garner the 216 votes it would need to pass the House, which it would likely have to do with no bipartisan support.

In Wyoming, where state lawmakers chose to not expand Medicaid under the Affordable Care Act through several legislative sessions, thousands were left without coverage. However, recent increases in premiums also came down on many covered under Obamacare in the state.

The state’s most recently elected member of Congress, Rep. Liz Cheney, R-Wyo., said she plans to support the bill.

“I’ve looked at it in depth, with a particular focus on what it would mean for Wyoming,” Cheney told the Wyoming Tribune Eagle on Tuesday.

Cheney said the Republican plan would give flexibility to states and individuals that would make insurance more affordable for consumers.

“The overall process is one that I feel very good about,” Cheney said. “I think it does exactly what we need to do in terms of replacing Obamacare with a system that really puts people back in charge.”

The nonpartisan Congressional Budget Office released its score of the Republican plan March 13, estimating the number of people covered could be reduced by as many as 24 million people by 2026, contradicting a campaign promise made by Republican President Donald Trump that no Americans would lose coverage. The CBO also estimates average premiums could go down significantly for younger, healthier Americans, while increasing for older Americans.

Joining other Republicans critical of the CBO analysis, Cheney said it isn’t an accurate look at what is likely to happen.

“They assume a stagnant situation with respect to the insurance market, and that isn’t what’s going to happen,” she said. “I think when you give people tax credits – and it’s important those tax credits are tied to a range of things, that they go up with age, because we need to make sure we are taking care of elderly populations – that’s the kind of policy that gives people the resources they need to make their own decisions and choices.”

Among changes made to the proposal late Monday was a directive to the Senate to develop a reserve account for those between ages 50 and 64 who would see premiums jump under the plan. Sources vary on how much the reserve would be, but they range from $75 billion to $85 billion. Cheney said she thought it was a good change for the bill.

“It’s an important fix,” she said. “I think it will help those costs.”

Additionally, an amendment would allow states to implement an optional work requirement for certain consumers to receive Medicaid. Cheney said the work requirement makes sense for Wyoming and would help with what she saw as a fatal flaw in Obamacare.

“There was a disincentive to work because the subsidies were structured toward premium prices, and as people’s premiums went up, the subsidies they received would also go up, and there was no ceiling on it,” she said. “This makes for a lot more of an effective approach to say, ‘Look, these are going to be tied primarily to age, and we are going to have a work requirement in here so we make sure we’re not pulling the rug out from anybody.’”

Another change in the “manager’s amendment” would allow states to convert Medicaid payments into block grants. The current law matches federal Medicaid spending with state spending for eligible beneficiaries without a set limit. Under the block grant plan, a cap would be set below expected spending based on current levels of need.

Cheney said the block grant proposal would allow Wyoming the flexibility to distribute funding as it sees fit.

“To really understand the changes that are going to be made, not just legislatively, but the understanding that states today face a tremendous burden in terms of what they have to do to get waivers (and) what they’ve got to do to make the program work for them,” she said. “I think these changes are going to let the states make the program work for them.”

Representatives are scheduled to work on the bill today in the House Rules Committee, of which Cheney is a member. She said more changes are likely to come before the bill goes to a vote.  

With some House members on both sides of the aisle questioning or opposing the bill, it’s not clear it has the support it needs to pass. But Cheney said she’s confident the bill would garner the votes it needs to pass Thursday.

More changes to the bill could come if it passes on to the other chamber. U.S. Sen. John Barrasso, R-Wyo., said he’s confident the American Health Care Act would be a better plan than Obamacare.

“The House proposal, as written right now, eliminates the mandates forcing people to buy insurance and eliminates taxes and penalties,” Barrasso said in an email to the WTE. “It still preserves the things that are important. It protects people with pre-existing conditions and allows young people up to age 26 to stay on their parents’ plan. It also eliminates the lifetime limits for people with serious illnesses. The legislation also includes measures to stabilize the insurance market. This will provide relief from the damage caused by Obamacare.”

U.S. Sen. Mike Enzi, R-Wyo., said in a statement that the House bill is “encouraging” and is “motivated by the right goals.”

“I’ll continue to look into the details of the House proposal as we get ready to consider health-care legislation in the Senate,” he said.

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