Health care bill outline emerges
Senate Medicaid cuts deeper
WASHINGTON — Senate leaders on Wednesday were putting the final touches on proposed legislation that would reshape a big piece of the U.S. health care system by rolling back Medicaid while providing a softer landing, compared with legislation passed by the House, to Americans who stand to lose coverage gained under former President Barack Obama’s law.
A discussion draft circulating Wednesday afternoon among aides and lobbyists would roll back the Patient Protection and Affordable Care Act’s taxes, scale down its Medicaid expansion, re-
jigger its subsidies, give states wider latitude in opting out of its regulations and eliminate federal funding for Planned Parenthood.
The bill largely mirrors the House measure that narrowly passed last month but with some significant changes.
While the House bill pegged federal insurance subsidies to age, the Senate measure would link them to income as the Affordable Care Act does. The Senate proposal cuts off Medicaid expansion more gradually than the House bill but would enact deeper long-term cuts to the health care program for low-income Americans. It also removes language restricting federally subsidized health plans from covering abortions, which may have run afoul of complex budget rules.
Senate Majority Leader Mitch McConnell, R-Ky., intends to present the draft to GOP senators at a meeting this morning.
“We believe we can do better than the Obamacare status quo, and we fully intend to do so,” said McConnell.
McConnell was unveiling his plan even as GOP senators from across the party’s political spectrum complained about the package and the secretive, private meetings he used to draft a measure reshaping the country’s health care system, which comprises one-sixth of the U.S. economy.
Facing unanimous Democratic opposition, Republicans can lose the votes of no more than two of their 52 senators and still push the measure through the Senate with Vice President Mike Pence breaking the tie. Enough have voiced concerns to make clear that McConnell and other leaders have work to do before passage is assured.
McConnell has vowed to hold a vote before senators go home for the July Fourth recess.
Aides stress that the GOP plan is likely to undergo more changes in order to garner the 50 votes Republicans need to pass it. Moderate senators are concerned about cutting off coverage too fast for those who gained it under Obama’s health care law, while conservatives don’t want to leave big parts of the Affordable Care Act in place.
Moderates who are on the fence about whether to support the overhaul are likely to be pleased at the bill’s approach to subsidies because they would be based on financial need, potentially preserving coverage for more people who got insured under the Affordable Care Act.
Subsidies are currently available to Americans earning up to 400 percent of the federal poverty level. Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill — but anyone below that line could get the subsidies if they’re not eligible for Medicaid.
Yet the Senate bill would go further than the House version in its approach to cutting Medicaid spending. In 2025, the measure would tie federal spending on the program to an even slower growth index than the one used in the House bill. That move could prompt states to reduce the size of their Medicaid programs.
In a move that is likely to please conservatives, the draft also proposes repealing all of the Affordable Care Act’s taxes except for its so-called Cadillac tax on high-cost health plans in language similar to the House version. Senators had previously toyed with the idea of keeping some of the Affordable Care Act’s taxes.
The House had a difficult time passing its own measure after a roller-coaster attempt, with the first version being pulled before reaching the floor after House Speaker Paul Ryan, R-Wis., determined he did not have the votes. House Republicans went back to the drawing board and passed their own measure — which would more quickly kill Medicaid expansion and provide less-generous federal subsidies — on May 4.
Even if the Senate measure does pass the upper chamber, it will still have to pass muster with the more conservative House before any legislation could be enacted.
REPORT ON OPIOID FIGHT
While awaiting a first glimpse at the Senate Republicans’ health care bill, the chamber’s Democrats and their allies were beginning to foment opposition by focusing
on different constituencies who they say would be harmed by the GOP plans.
The Democratic Policy and Communications Committee, led by Sen. Debbie Stabenow of Michigan, convened a hearing Wednesday afternoon on how the bill “would devastate rural America.”
The effort to draw attention to how rural communities could be affected comes a day after two other Democrats, Sens. Robert Casey Jr. of Pennsylvania and Joe Manchin of West Virginia, issued a report along with local law enforcement officials to dramatize how the nation’s ability to combat drug abuse would, in their view, be hurt by the GOP plan.
“The Republican health care plan would retreat from the fight against opioid addiction at the height of the epidemic,” warns the eight-page report, filled with charts, a national map showing deaths from drug overdoses and a description of ways Obama’s health care law has fostered access to treatment.
The sudden mobilization by senators ramps up what to date has been a relatively tepid campaign by groups off Capitol Hill. Though they oppose the Republican House bill and are worried about what the Senate majority is designing, they have had no actual Senate legislation against which to rail.
“It’s very challenging,” said Dick Woodruff, the American Cancer Society’s senior vice president of federal advocacy. Without that, members of his group continue to express concern about key elements of the American Health Care Act narrowly passed by the House last month. Those include a proposed Medicaid cut of more than $830 billion and a provision that could make it more costly and difficult for Americans with pre-existing medical conditions to obtain insurance.
This week, four groups focused on public health dispatched a joint statement faulting the complete lack of detail released by Senate Republicans. Their statement again decried the House’s legislation, especially its elimination of all money for a federal Prevention and Public Health Fund.
“The pain will be felt in every state, every congressional district, and every neighborhood,” the statement said, “and those who are most vulnerable will suffer the most.”
The cancer society has just started running print and online ads in several key states and is bringing cancer survivors to Capitol Hill on Tuesday along with groups representing patients with diabetes, multiple sclerosis and cystic fibrosis. The American Heart Association is also flying in some of its members to meet with lawmakers and their staffs.
Separately, Anthem Inc., the insurance company that has stuck with the Affordable Care Act longer than most other large health insurers, is shrinking its participation in the program and pulling out of two more states’ marketplaces.
Anthem announced its exit from Wisconsin and Indiana on Wednesday, the deadline in many states for U.S. insurers to file their premium rates if they wish to participate in the Affordable Care Act next year. The insurer said it will leave the two individual insurance markets because uncertainty has become too great to continue offering plans.
“While we are pleased that some steps have been taken to address the long term challenges all health plans serving the individual market are facing, the individual market remains volatile,” Anthem said in a statement. Pricing Affordable Care Act plans “has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations.”
Earlier this month, Anthem said that it would pull out of Ohio’s Affordable Care Act market.
Anthem sells coverage under the Blue Cross and Blue Shield brand in 14 states, including Arkansas.