The revised bill — which represents Senate Majority Leader Mitch McConnell’s latest bid to unite his fractious caucus — would still enact historic cuts in federal health care assistance to low- and moderate-income Americans and fundamentally scale back Medicaid’s half-century-old guarantee of health coverage for the poor.
“My goal is to create a more workable system that lowers the cost of coverage, provides access to quality care, and protects the most vulnerable in our society,” Sen. Rob Portman (R-Ohio) said. “I’ll review the text of this new legislation just like I did the last version, and I will review the analysis from the Congressional Budget Office when it becomes available.”
The new version would further loosen insurance requirements to allow health plans to offer stripped-down, cheaper plans, a move designed to win over skeptical conservative senators.
The new bill also includes a provision to expand the ability of Americans to use tax-deferred Health Savings Accounts to pay insurance premiums, a benefit primarily to those in higher income-tax brackets.
The bill would earmark additional federal money to help stabilize health insurance markets across the country, funded in part by two Obamacare taxes on wealthy Americans that it retains, in a break from previous GOP legislation that cut those taxes.
And in an effort to woo several GOP senators from states hit hard by the opioid crisis, McConnell earmarked an additional $45 billion in the bill to confront the epidemic.
McConnell, R-Ky., has been meeting behind closed doors with Republicans to adjust the legislation after he was forced to abandon a vote last month amid a revolt within his own party. The earlier version would have left 22 million more Americans uninsured and has been vehemently opposed by leading doctor, patient and other health care advocacy groups.
Several Republican senators said Thursday they were hopeful the changes to the legislation would allow it to advance, and Texas Sen. Ted Cruz, a conservative who opposed the original bill, said Thursday he would now support it.
“I think we’re making good progress,” said Senate Health Committee Chairman Lamar Alexander, R-Tenn.
But two GOP lawmakers — Maine Sen. Susan Collins and Kentucky Sen. Rand Paul — said they would still vote “no.” A number of other key lawmakers remained undecided.
With 52 members of his caucus, McConnell can afford to lose only two votes and still advance the legislation.
“I opposed the last draft of the Senate health proposal because I had concerns about the measure’s Medicaid policies, especially those that impact drug treatment for those suffering from addiction,” Portman said. “I’ve also consistently said that the Affordable Care Act isn’t working for many Ohio families and small businesses whose premiums and deductibles have skyrocketed, and choices have disappeared as health insurance plans have left Ohio. As this process moves forward, I will continue to work with my colleagues to ensure that our health care system works better for all Ohioans.”
The new version is still fiercely opposed by many patient advocates and others.
“The latest proposed changes to the Senate health care bill would make access to health coverage worse for those with pre-existing conditions like cancer,” said Chris Hansen, president of the American Cancer Society’s advocacy arm.
“The reluctance by senators to include patient feedback and other relevant stakeholder perspectives in the process is preventing the development of a reasonable, bipartisan consensus that could improve the law and pass the Senate.”
Also critical of the bill was Americans for Tax Reform President Grover Norquist, an influential conservative, who said it was a mistake to retain the two Obamacare taxes on high-income households.
“All Obamacare taxes should be repealed,” he said.
Sen. Sherrod Brown (D-Ohio) blasted the Senate’s revised healthcare bill, which like the earlier bill, will gut the Medicaid coverage supported by Ohio Gov. John Kasich, which has been Ohio’s No. 1 tool in combatting the opioid crisis.
The bill also allows insurance companies to once again to discriminate against individuals with pre-existing conditions and applies a double age tax on people ages 50 to 64 by allowing insurers to charge them up to five times more and reducing the tax credits currently available for them to buy insurance, Brown said.
“Just yesterday, I met with Ohio families whose children were born with diseases or disabilities that require special healthcare needs for the rest of their lives. Last week in Cincinnati, I sat across from a man who told me that without the Medicaid expansion, his daughter would have died from an opioid overdose. In Toledo, I talked to hard-working people over 50 who can’t afford an age tax that allows insurers to charge them five times more,” Brown said.
“How can a bunch of Washington politicians with taxpayer-funded healthcare look these people in the eye and tell them ‘we’re going to let insurance companies refuse to cover your child’s care’? How can they say ‘we’re gutting the best tool we have to combat the opioid crisis’? How can they raise costs on hard-working people just because they turn 50?”
“I’m ready to work with Republicans to lower costs and make healthcare work better, but that’s not what this bill does,” Brown added.
It remains unclear whether the new bill will resolve differences between the GOP’s conservative and centrist factions.
In fact, even before the revised bill was released, two Republican senators floated their own rival plan.
The alternative proposal — by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana — is only a general outline. It would preserve some taxes in the current health law while creating new block grants to ship billions of dollars to states, giving them broader authority to redesign their health insurance markets.
“We’re going to see which one can get 50 votes,” Graham told CNN.
There is no specific formula that indicates what this would mean for Medicaid, but the two senators suggest that the program would be restricted in future years by capping federal aid to states, much as other Republican proposals.
President Donald Trump told Christian Broadcasting Network founder Pat Robertson in an interview excerpt that aired Wednesday that he wants Congress to send him a bill to sign.
“I will be very angry about it and a lot of people will be very upset,” Trump said. Referring to McConnell, Trump added, “Mitch has to pull it off. He’s working very hard.”
But senators are worried GOP leaders don’t have the 50 votes needed from their 52-seat majority for a procedural vote to start debate of the health care bill on the Senate floor.
McConnell has indicated he intends to push ahead once the nonpartisan Congressional Budget Office has reviewed the revised legislation. The agency’s estimates are expected Monday.
The new approach sticks to the broad outline of McConnell’s first bill, the Better Care Reconciliation Act, with key revisions largely to bring conservatives such as Cruz on board.
Cruz demanded that the revised legislation bill further loosen requirements on health plans.
Cruz’s provision, the Consumer Freedom Option, would allow insurance companies to offer bare-bones plans that do not include the full set of currently required benefits, such as maternity care and treatment for mental illness and substance abuse.
Conservatives say the change will drive down premium costs for consumers.
But critics say Cruz’s plan essentially does away with Obamacare’s protections for patients with pre-exisitng medical conditions by allowing insurers to charge high rates to sick people who need more extensive insurance coverage and leaving everyone else with skimpy, if cheap, plans that provide inadequate coverage.
Thirteen patient groups — including the American Heart Association, the American Lung Association, the March of Dimes, AARP and the American Cancer Society’s advocacy arm — sent senators a strongly worded letter this week lambasting Cruz’s proposal as “a betrayal of the commitment to protect Americans from price discrimination based on a pre-existing health condition.”
And while Cruz’s plan has been pushed by the White House and has backing from conservative interest groups, other senators are not on board.
Many conservatives complain the bill does not go far enough toward repealing Obamacare. And they oppose retaining the two Obamacare taxes — a 3.8 percent investments tax and a 0.9 percent payroll tax — on high-income earners.
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