Se­nate’s health­care plan makes deep cuts

Repub­li­cans face fur­ther ne­go­ti­a­tions to sway both mod­er­ates and con­ser­va­tives un­happy with the bill.

Los Angeles Times - - FRONT PAGE - By Lisa Mascaro

WASH­ING­TON — Get ready for drama-filled days of mock hand-wring­ing, po­lit­i­cal jock­ey­ing and back­room brinkman­ship as the Se­nate GOP health­care plan heads to­ward a hope­d­for vote next week.

No sooner did Se­nate Ma­jor­ity Leader Mitch McCon­nell un­veil the lon­gawaited Oba­macare over­haul Thurs­day than Repub­li­can sen­a­tors started openly ne­go­ti­at­ing what it would take to win their votes.

Within just a few hours, four key con­ser­va­tive sen­a­tors — Ted Cruz of Texas, Mike Lee of Utah, Ron Johnson of Wis­con­sin and Rand Paul of Ken­tucky — jointly an­nounced they could not pos­si­bly vote for the bill as is, un­less it more fully guts the Af­ford­able Care Act.

Like­wise, cen­trists with­held their sup­port un­less they can push the bill the other way, as they ponder the fall­out from leav­ing mil­lions more Amer­i­cans unin­sured.

Even Pres­i­dent Trump — who called the House over­haul bill “mean” — ini­tially with­held his en­dorse­ment, sug­gest­ing “a lit­tle ne­go­ti­a­tion” would make the Se­nate ver­sion “very good.” Later in the day he tweeted he was “sup­port­ive” but looked “for­ward to mak­ing it very spe­cial!”

Al­most cer­tainly McCon­nell opened the door to the ha­rangu­ing by pre­sent­ing the leg­is­la­tion as a “dis­cus­sion draft” and invit­ing in­put to make it bet­ter.

Af­ter be­ing widely panned by Democrats and Repub­li­cans alike for craft­ing the bill with un­prece­dented se­crecy, keep­ing de­tails even from GOP sen­a­tors, McCon­nell may now be

GOP SE­NATE OP­PO­NENTS

At least four Repub­li­can sen­a­tors say they’re op­posed to the mea­sure as writ­ten — enough to keep it from pass­ing.

THE SE­NATE GOP PLAN

Some of the key points in the draft of the Se­nate Repub­li­can bill to re­place Oba­macare:

MED­I­CAID

The ex­pan­sion of ben­e­fits cur­rently of­fered un­der Oba­macare would be phased out be­gin­ning in 2020 and shut down com­pletely by 2024.

IN­SUR­ANCE COSTS

A new for­mula for set­ting the amount of sub­si­dies would tie them to the cost of less com­pre­hen­sive health plans. Many con­sumers would get sub­stan­tially less as­sis­tance than un­der Oba­macare.

IN­SUR­ANCE MAN­DATE

The Se­nate bill elim­i­nates the man­date, and, un­like the House bill, does not in­clude any penal­ties for peo­ple who do not main­tain cov­er­age.

GUAR­AN­TEED COV­ER­AGE

Un­like the House bill, in­sur­ers would not be al­lowed to charge sick peo­ple more. In­sur­ers would be able to charge older con­sumers five times more than younger con­sumers.

WOMEN’S HEALTH

States could seek waivers to al­low in­sur­ers to drop some ba­sic ben­e­fits, such as ma­ter­nity care and con­tra­cep­tives. Med­i­caid would be barred from pro­vid­ing fund­ing for any health clin­ics that of­fer abor­tion ser­vices, in­clud­ing Planned Par­ent­hood.

ea­ger to con­vey a sense of open de­bate and ne­go­ti­a­tion.

But if the process that played out in the House last month is any guide, ex­pect the deal-mak­ing to only go so far be­fore Repub­li­cans quickly unify — pre­fer­ring to hold hands and jump off the po­lit­i­cal cliff to­gether rather than risk los­ing their best op­por­tu­nity to ful­fill the Repub­li­can prom­ise to stop Oba­macare.

“Ev­ery­body is of­fer­ing in­put right now, and it’s go­ing to be a busy week­end,” said Sen. John Kennedy of Louisiana, who was still con­sid­er­ing the leg­is­la­tion. “I don’t know whether it will change or not, but I know a lot of peo­ple are in good faith and in earnest about of­fer­ing ad­di­tional sug­ges­tions, and we’ll prob­a­bly go right up to the dead­line.”

With Repub­li­cans hold­ing a slim ma­jor­ity, lead­ers can only af­ford to lose sup­port from two GOP sen­a­tors and still pass the bill in the face of unan­i­mous Demo­cratic op­po­si­tion.

In many ways, the ne­go­ti­a­tions will give sen­a­tors some­thing they have not had dur­ing the craft­ing of the bill be­hind closed doors: a chance to pub­licly mus­cle and ma­neu­ver their con­cerns to the fore­front of the de­bate.

Even if sen­a­tors are not suc­cess­ful in chang­ing the bill, they will be able to show their con­stituents that at least they tried.

“This cur­rent draft does not have the votes to pass the Se­nate,” Cruz told re­porters.

He is push­ing for steeper cuts to Med­i­caid and fewer re­quire­ments re­lated to the es­sen­tial ben­e­fits that in­sur­ers must cover.

But Cruz added, “We can get there.”

Vot­ing is ex­pected by the end of next week, a self-im­posed dead­line as Repub­li­cans worry that end­less de­bates over re­peal­ing Oba­macare would dom­i­nate the con­gres­sional agenda and leave them — and Trump — with few other leg­isla­tive acThey com­plish­ments.

A de­lay would also give op­po­nents more time to build up public mo­men­tum against the bill, as Democrats and many health­care groups are al­ready scram­bling to do.

Pro­test­ers have ral­lied out­side the Capi­tol and, on Thurs­day, more than 40 peo­ple, in­clud­ing many in wheel­chairs, were ar­rested out­side McCon­nell’s of­fice. warned that the pro­posed Med­i­caid cuts threaten to cut off fed­eral money that al­lows dis­abled peo­ple to live in­de­pen­dently.

A week can be a po­lit­i­cal life­time in Wash­ing­ton, and few sen­a­tors are will­ing to com­pro­mise so soon on an is­sue that has loomed so large over the party.

The risks are clear. If Repub­li­cans fail to re­peal Oba­macare af­ter years of promis­ing to do so, they face the wrath of con­ser­va­tive vot­ers and out­side groups.

But if their over­haul leaves mil­lions of Amer­i­cans with­out cov­er­age or raises costs, the back­lash could be in­tense.

Polls show that Oba­macare’s pop­u­lar­ity has soared since re­peal ef­forts be­gan, and Amer­i­cans largely op­pose the House bill.

But even among vot­ers, the pol­i­tics that have al­ways sur­rounded Oba­macare play a role. Ac­cord­ing to a June 13 YouGov poll, 56% of Repub­li­cans said they sup­ported the House bill. But when com­pared to keep­ing Oba­macare, 68% said they pre­ferred the House bill.

By band­ing to­gether as a uni­fied front of op­po­si­tion, Cruz, Paul and other con­ser­va­tives are bor­row­ing from a strat­egy that proved ef­fec­tive for the House Free­dom Cau­cus, which with­held a block of votes to de­mand changes to the House ver­sion.

Just as the con­ser­va­tive cau­cus opened a di­rect line of ne­go­ti­a­tion with the White House, Paul said he had spo­ken per­son­ally to Trump this week about changes the sen­a­tors wanted to make to the bill.

“We’ll see what kind of olive branch or re­ac­tion we get to our com­ments, and if they’re open to ne­go­ti­a­tion,” Paul said. “I think we have a chance of ne­go­ti­at­ing as a team, and it’s much greater than ne­go­ti­at­ing in­di­vid­u­ally.”

But as the days drag on, McCon­nell will soon bump into the same prob­lem that con­fronted Speaker Paul D. Ryan as the House made changes to win con­ser­va­tive votes but ended up chas­ing away more cen­trist Repub­li­cans.

Sen­a­tors from Ohio, West Vir­ginia and other states that ex­panded Med­i­caid un­der Oba­macare are con­cerned about cut­ting con­stituents off health­care, par­tic­u­larly as their re­gions reel from the opi­ate ad­dic­tion cri­sis.

“I have se­ri­ous con­cerns about the bill’s im­pact on the Ne­vadans who de­pend on Med­i­caid,” said Sen. Dean Heller, who is per­haps the most en­dan­gered Repub­li­can up for re­elec­tion next year. “If the bill is good for Ne­vada I’ll vote for it, and if it’s not — I won’t.”

Like­wise cur­tail­ing fund­ing for clin­ics and in­sur­ance plans that pro­vide abor­tion ser­vices may win con­ser­va­tive sup­port, but it poses a prob­lem for sev­eral key Repub­li­can women, in­clud­ing Sens. Su­san Collins of Maine and Lisa Murkowski of Alaska.

But all the ob­jec­tions and op­po­si­tion may fade with next week’s dead­line for pass­ing the bill be­fore a long Fourth of July hol­i­day re­cess.

Few sen­a­tors want to risk be­ing the one re­spon­si­ble for de­rail­ing the leg­is­la­tion.

Sen. Tim Scott of South Carolina ac­knowl­edged the op­po­si­tion among his GOP col­leagues, but re­mained op­ti­mistic for pas­sage. He was lean­ing to­ward vot­ing yes.

“We’re get­ting there,” Scott said. “Hope­fully over the next week we’ll have a chance to just calm their fears and get folks to stay on the team.”

‘I think we have a chance of ne­go­ti­at­ing as a team, and it’s much greater than ne­go­ti­at­ing in­di­vid­u­ally.’ — Sen. Rand Paul, one of four con­ser­va­tive sen­a­tors op­posed to the bill

J. Scott Applewhite As­so­ci­ated Press

MA­JOR­ITY LEADER Mitch McCon­nell says the plan would “shift power ... to the states so they have more f lex­i­bil­ity to pro­vide more Amer­i­cans with the kind of af­ford­able in­sur­ance op­tions they ac­tu­ally want.”

Getty Images

RAND PAUL

Getty Images

TED CRUZ

As­so­ci­ated Press

MIKE LEE

Getty Images

RON JOHNSON

Michael Reynolds Euro­pean Pressphoto Agency

SEN. TED CRUZ of Texas, cen­ter, is one of four con­ser­va­tives now op­posed to the Se­nate bill. “We can get there,” he says about ne­go­ti­a­tions that will in­ten­sify in the com­ing days to se­cure votes for pas­sage.

Mark Wil­son Getty Images

SEN. RAND PAUL says he has spo­ken to Pres­i­dent Trump this week about changes he and other con­ser­va­tive sen­a­tors want to make to the bill.

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