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theodore M I R A L D I mpa ... editor, publisher, writer
Friday, June 23, 2017
Senate HEALTH CARE Bill Softens Edges of House Plan
With Tax Subsidies and Medicaid Expansion
Tom Howell Jr.
Republican leaders faced an immediate backlash Thursday after revealing their Obamacare replacement bill, leaving campaign vows to repeal the 2010 health care law in doubt as the Senate pushes toward a showdown on the chamber floor next week.
The bill, announced by Majority Leader Mitch McConnell, softens the edges of an earlier House version that President Trump reportedly called “mean.”
The 142-page plan would extend the life of President Obama’s Medicaid expansion and offer more generous subsidies for the poor and those approaching retirement age. It removes Obamacare’s “individual mandate” and unwinds the health care exchanges, but it maintains the 2010 law’s guarantees that let young adults stay on their parents’ plans and guarantees coverage despite pre-existing conditions.
“Obamacare is a direct attack on the middle class, and American families deserve better than its failing status quo — they deserve better care,” Mr. McConnell said as he went to the Senate floor to publicly announce the plan, which was drafted in secret.
Democrats uniformly oppose the bill, meaning Republicans cannot lose more than two of their 52 members in a vote.
Yet four have already said they can’t vote for it, as it stands.
Sens. Rand Paul of Kentucky, Ron Johnson of Wisconsin, Ted Cruz of Texas and Mike Lee of Utah said they opposed the draft legislation for a variety of reasons, but they are open to negotiation before the bill hits the floor.
Mr. Johnson said he feels rushed, while the others worry that they are turning the dials on Obamacare instead of fulfilling their pledge to kill it.
“Somebody’s going to have to look at this bill and say we’re going to make it look more like repeal and less like we’re keeping Obamacare,” Mr. Paul said.
Democrats, meanwhile, say the bill is still too much of a repeal and not enough of Obamacare. They have said they won’t cooperate until Republicans agree to keep the basic structure of the 2010 Affordable Care Act, then work on fixes.
“We live in the wealthiest country on earth. We’re proud of it as we should be. But surely, we can do better than what the Republican health care bill promises,” said Senate Minority Leader Charles E. Schumer, New York Democrat.
Democrats also have complained about the path of the bill, which Mr. McConnell wrote and which will head straight to the floor, bypassing the extensive committee process that characterized the Obamacare debate.
Mr. McConnell promised to wait for a Congressional Budget Office evaluation of the bill and said there will be a robust floor debate, including amendments.
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 said they needed time to read the whole bill, though they felt the proposals were trending in the right direction.
From the White House, President Trump said the Senate’s health care bill is in good shape but needs a “little negotiation.”
The CBO is expected to release its score next week, detailing how the bill affects federal spending and health care coverage.
Its evaluation of the House bill, which passed that chamber last month, projected lower costs for most Americans but said the poor and those approaching retirement age would see premium hikes. Some 23 million fewer Americans would hold insurance a decade from now because Medicaid’s rolls would be cut and people would no longer be required by law to purchase insurance.
Senators tried to lower costs for the poor and older Americans, pegging tax credits for people who buy insurance on their own to their amount of income instead of just age. That cuts 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, a Louisiana Republican and physician.
The plan also goes more slowly in curtailing Obamacare’s expansion of Medicaid, which the House plan froze 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 under 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 that the cuts will suddenly pull coverage from needy residents and cripple the fight against opioid addiction. The federal-state program covers 1 in 5 Americans, about half of U.S. births and two-thirds of nursing home residents.
A number of Republicans withheld judgment, saying they will go back and talk to their governors and state health care officials and see how the bill affects them.
“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 a key holdout.
He is considered one of the most vulnerable Republicans on an otherwise favorable Senate electoral map next year.
Another swing vote, Sen. Susan M. Collins of Maine, said the plan has pros and cons that deserve more scrutiny.
The bill would let states use Obamacare’s waiver system to drop aspects of the 2010 law, including its list of essential benefits that plans must cover. However, states cannot let insurers deny people with pre-existing conditions or charge them more than healthy consumers, a concept known as “community rating.”
Mr. Cruz and Mr. Lee had been pushing to scrap more of the regulations on insurers, not less, and House conservatives who will revisit the final plan insisted on letting states waive community rating.
The bill does strip federal funding from Planned Parenthood, the country’s largest network of abortion clinics, making good on a Republican campaign pledge.
In a boon for insurers, Republicans said the bill would maintain through 2019 the cost-sharing payments to insurance companies that cover out-of-pocket health care expenses of the poor. Mr. Trump has threatened to withhold those payments.
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.
“Let’s be very clear: Senate Republicans are paying for tax cuts for the wealthy with American lives,” said Sen. Elizabeth Warren, Massachusetts Democrat.
Mr. Obama also weighed in to decry the changes to his signature law.
“The Senate bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America,” Mr. Obama said on Facebook. “It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else.”
Republicans have described their repeal effort as a mission to rescue Americans from a law headed for failure. They point to rising premiums and dwindling choices, as insurers pull out of markets.
Sen. John Cornyn, Texas Republicans, said the cruelest lawmakers of all were Democrats defending the “failed experiment” of Obamacare.
“They may not be willing to help, but we will,” he said. “And we will get it done and help the American people who are being hurt by the failure of Obamacare today.”