GOP takes fresh aim at Obamacare
Senate leaders unveil new version of health plan overhaul, but divisions give bill uncertain future.
Senate Republican leaders unveiled a fresh proposal Thursday to repeal and replace the Obama-era health care law, revising their bill to help hold down insurance costs for consumers while keeping a pair of taxes on high-income people that they had planned to eliminate.
But the measure was immediately imperiled when two Repub- lican senators, moderate Susan Collins of Maine and conservative Rand Paul of Kentucky, announced they were not swayed — even on a procedural motion to take up the bill next week.
One more defection would deny the votes needed for passage, dooming the bill and jeop- ardizing the Republicans’ 7-yearold quest to dismantle the health law that is a pillar of President Barack Obama’s legacy. In a sign that more could follow, two other Republican senators, Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, unveiled their own alternative plan, just minutes before Senate leaders offered their latest version.
Sen. Shelley Moore Capito, R-W.Va., expressed “serious concerns about the Medicaid provisions” in the latest draft, although she did not reject it.
With the revised bill, Senate Majority Leader Mitch McConnell had hoped to secure the 50 votes he needs for Senate passage. But the changes may not have been enough to bridge the vast divide that has opened between the Senate’s most conservative Republicans, who have vowed to destroy the health care law “root and branch,” and its moderate Republicans, who worry that deep cuts to Medicaid would leave too many in their states without health care.
Republicans said the revised bill would provide roughly $70 billion in additional funds that states could use to help reduce premiums, hold down outof-pocket costs and otherwise make health care more affordable. The bill already included more than $100 billion for such purposes.
But the new bill, like earlier versions, would still convert Medicaid from an openended entitlement to a system of fixed payments to states. In the event of a public health emergency, state Medicaid spending in a particular part of a state would not be counted toward the spending limits, known as per capita caps, a concession to moderate Republicans but perhaps not enough to get the votes needed for passage.
Overall, the new version of the bill made broad concessions to conservative Republicans who had maintained that the initial draft left too much of the health care law in place. McConnell then backfilled the bill with money intended to placate moderates. That jury-rigging of the bill left neither side completely satisfied.
For instance, in a departure from current law, the bill would allow insurers, under certain conditions, to offer health plans that do not comply with standards in the Affordable Care Act. Under that law, insurers sell regulated health plans through a public insurance exchange in each state.
Health care experts worried that such a change would send healthy consumers to low-cost, basic health plans, leaving sick and older consumers to buy more comprehensive health policies at much higher prices. To compensate, Republican leaders added billions of dollars to try to offset rising premiums.
Sen. Ted Cruz, R-Texas, had pushed to allow strippeddown plans, and he called the inclusion of the provision “very encouraging.”
“I think failing to get this done would be really catastrophic,” Cruz said on Phoenix radio station KFYI, “and I don’t think any of the Republican senators want to see failure come out of this.”
But Paul, an ardent conservative, remained implacably opposed. Another conservative, Sen. Mike Lee of Utah, said he was undecided.
In another change, people who enroll in catastrophic health insurance plans would be eligible for federal tax credits to help pay premiums. Such plans typically have lower premiums and high deductibles. But under the Affordable Care Act, consumers generally cannot use the tax credits for such plans.
But the revised bill is broadly similar to the earlier measure that Senate leaders hoped to vote on before the Fourth of July recess.
“It appears that little has changed at the core of the bill,” Senate Democratic leader Chuck Schumer said on the Senate floor. “The Republican Trumpcare bill still slashes Medicaid. The cuts are every bit as draconian as they were in the previous version — a devastating blow to rural hospitals, to Americans in nursing homes, to those struggling with opioid addiction and so many more.”
Like the previous bill, it would end the requirement that most Americans have health coverage, and it would make deep reductions in the growth of Medicaid, capping payments to states and rolling back its expansion under the Affordable Care Act. Though some Republican senators had expressed concern about how the previous bill would affect Medicaid, Senate leaders stuck with the same approach in the new version.
In a notable change, the bill would keep the two taxes imposed by the Affordable Care Act on people with high incomes: the 3.8 percent tax on investment income and the 0.9 percent payroll tax. The taxes apply to individuals with income over $200,000 and couples with income over $250,000.
Both of those taxes would have been repealed under the previous Senate bill, reducing federal revenue by about $231 billion over a decade, according to the congressional Joint Committee on Taxation.
Republicans expect that an analysis of the new bill will be released by the nonpartisan Congressional Budget Office early next week.
The previous bill would have increased the number of people without health insurance by 22 million in 2026 compared with the Affordable Care Act, the budget office found.
McConnell has said he intends to take up the revised bill next week, although it is unclear if he will try to move ahead if he does not know for sure whether he had the votes to begin debate — or to ultimately pass the bill.