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theodore M I R A L D I mpa ... editor, publisher, writer
Thursday, June 22, 2017
Senate GOP Unveils Obamacare REPLACEMENT
Offers tax subsidies for poor, Medicaid expansion
What about Medicare? Obama slashed services in the Billions to fund ObamaCare. Will Senior Services be restored?...tmiraldi
Tom Howell Jr.
Senate Republicans’ new Obamacare replacement plan softens the edges of the House bill that President Trump reportedly called “mean,” offering more generous tax subsidies for the poor to buy insurance and extending the lifespan of President Obama’s Medicaid expansion.
But the bill, which GOP leaders revealed Thursday morning as a “discussion draft,” maintains the same basic outline as the House proposal, repealing Obamacare’s “individual mandate” and the health exchanges and replacing them with tax credits aimed at helping those who don’t get coverage through their jobs buy plans on the individual market.
The 142-page plan would also strip federal funding from Planned Parenthood, the country’s largest network of abortion clinics.
Now Senate Majority Leader Mitch McConnell, who was the chief architect of the plan, must sell it to wary conservatives and moderates within his own party, and with a narrow margin of error.
Mr. McConnell revealed the closely held bill to Republicans after weeks of closed-door negotiations that were panned by members of both parties as overly secretive.
GOP leaders didn’t want wary Republicans to get cold feet amid loud criticism of their plans, since they’re already struggling to pin down 50 GOP votes from their 52-seat majority.
Mr. McConnell emerged from the morning briefing to say Republicans were in agreement on the big issues. He also promised a “robust” floor debate with the chance for amendments.
“It’s time to act, because Obamacare is a direct attack on the middle class,” the Kentucky Republican said.
Some rank-and-file Republicans seemed to like what they saw.
“It’s much better than Obamacare. I like this a lot better than the house bill,” said Sen. David Perdue, Georgia Republican.
Others were guarded, saying they needed time to read the whole bill, though felt things were trending in the right direction.
“A work in progress,” Sen. Pat Toomey, Pennsylvania Republican, said.
The Congressional Budget Office is expected to “score” how it affects federal spending and health coverage in the coming days, clearing the way for a floor vote later. Republicans had been aiming for a vote next week, but Mr. McConnell said only that the debate would start next week.
The House passed its bill on a 217-213 vote last month.
The Senate’s plan’s tax credits for people who buy insurance on their own peg the amount to income instead of just age, cutting a middle ground between the House plan and Obamacare.
“For example, the tax credits for older folks — people like me — are now age-adjusted and income-adjusted, so someone who is making $20,000 a year and 62 years old would be able to afford coverage under this, where under the [House bill] I think it was problematic if they could afford coverage,” said Sen. Bill Cassidy, Louisiana Republican who said the evolving plan is starting to satisfy Mr. Trump’s vow to protect the sick.
The new plan also goes more slowly in curtailing Obamacare’s expansion of Medicaid, which the House plan had frozen in 2020. The Senate bill would begin a gradual reduction in 2021 and return to pre-Obamacare levels in 2024.
To placate fiscal hawks, the plan would allow Medicaid spending to rise at a slower rate than in the House version, starting in 2025.
Republicans say reining in Medicaid spending will force states to focus on those who need it most, though moderates worry the cuts will pull the rug out from thousands of constituents who received coverage for the first time under President Obama.
“At first glance, I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid,” said Sen. Dean Heller, Nevada Republican and key holdout. “I will read it, share it with Governor [Brian] Sandoval, and continue to listen to Nevadans to determine the bill’s impact on our state.”
Mr. Heller and Sen. Jeff Flake, Arizona Republican, are considered the most vulnerable Republicans in an otherwise favorable Senate map for the GOP in 2018.
Meanwhile Sen. Susan Collins, Maine Republican and key swing vote, said she will be “particularly interested” in the CBO’s analysis on “the impact on insurance coverage, the effect on insurance premiums, and the changes in the Medicaid program.”
Republicans said the new bill would maintain through 2019 the controversial cost-sharing payments to insurance companies that cover out-of-pocket health expenses of the poor. President Trump has threatened to withhold those payments.
CBO analysts said the House version would have resulted in 23 million fewer people holding insurance a decade from now.
The plan would repeal Obamacare’s taxes on health insurers, medical device makers and high earners, among others, prompting Democrats to blast it as a wealth transfer from the needy to those who are doing fine.
“After all the talk about throwing out the House bill and starting fresh, the Senate proposal still slashes Medicaid to fund big tax breaks for the wealthy, raises costs and guts protections for people with pre-existing conditions,” Sen. Ron Wyden, Oregon Democrat, said. “This proposal makes clear that Senate Republicans intend to gamble with Americans’ health care to score a political victory.”
House Minority Leader Nancy Pelosi said she suspected the GOP’s draft bill was purposely written harshly, so that Republicans could later amend it to say they’d made it more generous.
Thursday’s unveiling created a palpable buzz around the Capitol, where Senate Republican were forced to walk a gauntlet of reporters after a closed-door briefing on the plan, clogging the hallways. The political fight spilled onto the Senate floor, where senior Republican Sen. John Cornyn of Texas blasted Democrats who filled the chamber for defending a “failed experiment” in Obamacare.
Sen. Robert Menendez, New Jersey Democrat, volleyed back, saying the GOP plan would “make the Wicked Witch of the West cringe.”