Senate Republicans unveil new health bill
Cruz calls proposal improved but others in GOP express doubt.
Senate Republican leaders on Thursday unveiled a fresh proposal to repeal and replace the Affordable Care Act, revising their bill to help hold down insurance costs for consumers while allowing insurers to sell new low-cost, strippeddown policies.
Those changes and others — including a decision to keep a pair of taxes on high-income people and to expand the use of tax-favored health savings accounts — were intended to bridge a vast gap between the Senate’s most conservative Republicans, who want less regulation of health insurance, and the moderate Republicans concerned about people who would be left uninsured.
But Republican leaders will have to battle for votes before a final showdown they hope will come next week. Two Republican senators, Susan Collins of Maine, a moderate, and Rand Paul of Kentucky, a conservative, said they were not swayed enough even to support a procedural motion to
take up the bill for debate. Several others, from both
sides of the party’s ideolog- ical spectrum, expressed misgivings. Sen. Mike Lee of Utah, a strong conserva- tive, said, “The new Senate health care bill is substan- tially different from the version released last month, and it is unclear to me whether it has improved.”
Republican moderates were upset by cuts to Medicaid, the health program for low-income people. Sen. Shelley Moore Capito of West Virginia expressed “serious concerns about the Medic- aid provisions” in the latest draft, as did Sen. Rob Port- man of Ohio.
“I want to make sure that with regard to those peo- ple who are currently getting coverage under Medicaid expansion, that we have some options for them,” Portman said.
Two other Republican senators, Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, went on television to promote their own alternative plan, just minutes before Senate leaders offered their latest version.
With 52 Republicans in the Senate, and two firm “no” votes already, a sin- gle new defection would doom the bill and jeopar- dize the Republicans’ seven-year quest to dismantle the health law that is a pillar of President Barack
Obama’s legacy. Democrats probed for weaknesses in the Repub-
lican ranks. “The Republican Trumpcare bill still slashes Medicaid,” said Senate Democratic leader Chuck Schumer. “The cuts are every bit as draconian as they were in the previous version — a devastating blow to rural hospi- tals, to Americans in nurs- ing homes, to those strug- gling with opioid addiction and so many more.”
Overall, the new version of the Senate bill made broad concessions to conservative Republicans who had said that the initial draft left too much of the Affordable Care Act in place. Senate Majority Leader Mitch McConnell
then backfilled the bill with money intended to placate moderates. The resulting mix left neither side completely satisfied.
The revised bill, like earlier versions, would roll back the expansion of Medicaid under the Affordable Care Act, and it would still convert Medicaid from an open-ended
entitlement to a system of fixed payments to states. However, in the event of a public health emergency, the resulting surge in state Medicaid spending would not be counted toward the spending limits, known as per capita caps — a concession to moderate Republicans. The revised bill would pro
vide roughly $70 billion in additional funds that states could use to help reduce premiums and hold down out-of-pocket medical costs.
In a departure from cur- rent law, the bill would allow
insurers, under certain conditions, to offer health plans that did 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
and must provide “essential health benefits,” such as maternity care, emergency services and mental health coverage.
Under the Senate bill, if an insurer offered several plans on state exchanges that were subject to the Afford- able Care Act mandates, it could also offer coverage outside the exchanges that would be exempt from most of those regulations. Insur- ance plans could escape from
some of the most important consumer protections in the Affordable Care Act, such as prohibitions on discrimination based on a person’s health status, medical condition, claims experience, medical history or disability.
This part of McConnell’s bill, incorporating ideas from Sen. Ted Cruz, R-Texas, was tacked onto the end of the bill and is enclosed in brackets. Aides to Senate Republi- cans said the brackets meant that the language was not final and could be revised in light of comments from other senators.
Cruz said the inclusion of this provision was “very encouraging,” and he called
the revised bill a “substan- tial improvement.”
But insurers and consumer advocates worried that the new provision would send healthy consumers to low
cost, basic health plans, leav- ing sick and older consumers to purchase more comprehensive health policies at much higher prices.
To compensate, Republican leaders allocated tens of billions of dollars in their bill to try to offset rising premiums. Consumers could not use federal tax credits to help pay premiums for coverage that did not meet federal insurance standards.
Sen. Chris Coons, D-Del., said the section of the bill based on Cruz’s proposal “would allow insurers to offer junk health insurance plans.”
“To me, that is like allowing car companies to sell cars without air bags, bum- pers, or emergency brakes,” Coons said. “It might make the cars cheaper, but the cars are too dangerous to drive.”
The bill would, for the first time, allow people to use tax-favored health savings accounts to pay insurance premiums. Republicans said this policy change would increase health care coverage. The bill also provides $45
billion to help combat the opioid abuse crisis — a provision that was particularly important to two Republican senators who opposed the previous version of the bill, Portman and Capito.
In a notable change, the revised bill would keep two taxes imposed by the Affordable Care Act on peo- ple with high incomes: a 3.8 percent tax on investment income and a 0.9 percent payroll tax. The taxes apply to individuals with income over $200,000 and couples with income over $250,000.
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 revised bill will be released by the non- partisan Congressional Budget Office early next week. The previous version would have increased the number of people without health insurance by 22 million in 2026 compared with current law, the budget office found.
McConnell said he would then move to take up the bill for debate, amendments and a final vote — if he can get 50 willing senators.