Se­nate GOP re­leases new try at health care

Two Repub­li­cans al­ready an­nounce ‘no’ votes

Northwest Arkansas Democrat-Gazette - - FRONT PAGE -

WASH­ING­TON — Repub­li­can lead­ers un­veiled a new health care bill Thurs­day in their ef­fort to re­peal and re­place the 2010 Af­ford­able Care Act. They im­me­di­ately lost two key Se­nate votes, leav­ing none to spare as Repub­li­cans look to move for­ward on the bill.

Pres­i­dent Don­ald Trump de­clared a day ear­lier that fail­ure would make him “very an­gry” and that he would blame Se­nate Ma­jor­ity Leader Mitch McCon­nell of Ken­tucky.

But talk­ing with re­porters aboard Air Force One en route to France, Trump also ac­knowl­edged the chal­lenges law­mak­ers face.

“I’d say the only thing more dif­fi­cult than peace be­tween Is­rael and the Pales­tini­ans is health care,” Trump said. “But I think we’re go­ing to have some­thing that’s re­ally good and that peo­ple are go­ing to like.”

The re­worked bill McCon­nell pre­sented to fel­low Repub­li­cans aims to win con­ser­va­tives’ sup­port by let­ting in­sur­ers sell low-cost, skimpy poli­cies. At the same time,

the bill seeks to pla­cate hes­i­tant mod­er­ates by adding bil­lions to com­bat opi­oid abuse and help con­sumers with sky­rock­et­ing in­sur­ance costs.

Mod­er­ate Sen. Su­san Collins of Maine told re­porters she had in­formed McCon­nell she would be vot­ing against be­gin­ning de­bate on the bill, cit­ing in part cuts in the Med­i­caid health pro­gram for the poor and dis­abled. Sen. Rand Paul of Ken­tucky, who has re­peat­edly com­plained that McCon­nell’s ef­forts don’t amount to a full-blown re­peal of the Af­ford­able Care Act, also an­nounced he was a “no.”

That means McCon­nell can­not lose any other Repub­li­can sen­a­tors’ votes. With Democrats unan­i­mously op­posed in a Se­nate split 52-48 in fa­vor of the GOP, he needs 50 votes, with Vice Pres­i­dent Mike Pence break­ing the tie, to get past a pro­ce­dural hur­dle and be­gin de­bate on the bill.

The show­down vote is set for next week, though McCon­nell could can­cel again if he’s short of sup­port. He and other GOP lead­ers are urg­ing sen­a­tors to at least vote in fa­vor of open­ing de­bate, which would open the mea­sure up to amend­ments. And GOP lead­ers ex­press op­ti­mism that they are get­ting closer to a ver­sion that could pass the Se­nate.

“It’s in the best shape it’s been in so far,” said Sen. Roy Blunt of Mis­souri. “Now that mem­bers ac­tu­ally have pa­per in their hand they can look at what is likely to be very close to the fi­nal bill we’ll be vot­ing on and move for­ward.”

McCon­nell said the 172-page leg­is­la­tion is the sen­a­tors’ op­por­tu­nity to make good on years of prom­ises.

“This is our chance to bring about changes we’ve been talk­ing about since Oba­macare was forced on the Amer­i­can peo­ple,” he said.

Through­out the day McCon­nell hud­dled in his of­fice with hold­outs, in­clud­ing Dean Heller of Ne­vada, the most en­dan­gered Se­nate Repub­li­can in next year’s midterms, Shel­ley Moore Capito of West Vir­ginia, Rob Port­man of Ohio and John Ho­even of North Dakota.

The law­mak­ers wanted de­tails and num­bers on how the bill would af­fect ru­ral and Med­i­caid-de­pen­dent peo­ple in their states. All had op­posed McCon­nell’s ear­lier bill, but this time around sev­eral ex­ited their meet­ings say­ing they were un­de­cided and needed more time to eval­u­ate the leg­is­la­tion.

Capito ex­pressed “se­ri­ous con­cerns about the Med­i­caid pro­vi­sions” in the lat­est draft, although she did not re­ject it.

Ho­even said of McCon­nell: “He’s ask­ing every­body to work with him, and a lot of us are say­ing ‘yeah,’ and we’ve got more work to do.”

Nei­ther of Ar­kan­sas’ sen­a­tors were ready Thurs­day to en­dorse the lat­est draft.

In an email, a spokesman for Tom Cot­ton said the se­na­tor would be unavail­able for com­ment “but I can tell you

he’s re­view­ing the leg­is­la­tion that was re­leased to­day.”

In a writ­ten state­ment, Sen. John Booz­man said he was en­cour­aged that McCon­nell was work­ing to come up with a plan that Repub­li­can sen­a­tors could rally around.

“We are try­ing to de­ter­mine whether or not this re­vised Se­nate bill will be able to ac­com­plish our goal of im­prov­ing health care for all Amer­i­cans. I have the text and will be eval­u­at­ing it,” he said. “The good news is we all want to get to ‘yes.’”

WHAT’S DIF­FER­ENT

The re­vised bill is broadly sim­i­lar to the ear­lier mea­sure that Se­nate lead­ers hoped to vote on be­fore the Fourth of July re­cess, though the new ver­sion in­cludes some ad­di­tional pro­vi­sions meant to en­tice re­luc­tant Repub­li­can sen­a­tors with vary­ing pol­icy con­cerns.

“It ap­pears that lit­tle has changed at the core of the bill,” the Se­nate Demo­cratic leader, Charles Schumer of New York, 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 leg­is­la­tion ear­lier passed by the House after strug­gles of its own, the Se­nate bill would get rid of the Af­ford­able Care Act’s man­dates for in­di­vid­u­als to buy in­sur­ance and for em­ploy­ers to of­fer it, re­peal taxes and un­wind the Med­i­caid ex­pan­sion cre­ated by the Af­ford­able Care Act. Analy­ses by the Con­gres­sional Bud­get Of­fice have found the House bill and the ear­lier Se­nate ver­sion both would kick more than 20 mil­lion peo­ple off the in­sur­ance rolls over the next decade.

The new bill con­tains lan­guage de­manded by con­ser­va­tive Sen. Ted Cruz of Texas let­ting in­sur­ers sell plans with min­i­mal cov­er­age, as long as they also sell poli­cies that meet strict cov­er­age re­quire­ments set by the 2010 statute. Mod­er­ate Repub­li­cans have ob­jected that that would make poli­cies ex­ces­sively costly for peo­ple with se­ri­ous ill­nesses be­cause healthy peo­ple would flock to the cheaper cov­er­age.

The Cruz pro­vi­sion ap­pears in the leg­isla­tive text in brack­ets, mean­ing spe­cific lan­guage is still be­ing com­posed. That could give

McCon­nell, Cruz and other con­ser­va­tives time to work out a pro­vi­sion with broader sup­port.

Health care ex­perts wor­ried that such a change would send healthy con­sumers to low-cost, ba­sic 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.

Cruz called the in­clu­sion of the pro­vi­sion “very en­cour­ag­ing.”

“I think fail­ing to get this done would be re­ally cat­a­strophic,” Cruz said on the ra­dio sta­tion KFYI, “and I don’t think any of the Repub­li­can sen­a­tors want to see fail­ure come out of this.”

The re­tooled mea­sure re­tains McCon­nell’s plan to phase out the ex­tra money 31 states have used to ex­pand Med­i­caid un­der the 2010 law, and to tightly limit the over­all pro­gram’s fu­ture growth. Since its creation in 1965, Med­i­caid has pro­vided open-ended fed­eral funds to help states pay the pro­gram’s costs.

The rewrit­ten pack­age would add $70 bil­lion to the $112 bil­lion McCon­nell orig­i­nally sought that states could use to help in­sur­ers curb the growth of pre­mi­ums and con­sumers’ other out-of-pocket costs.

It has an added $45 bil­lion for states to com­bat the mis­use of drugs such as opi­oids. That’s a boost over the $2 bil­lion in the ini­tial bill, an ad­di­tion de­manded by Repub­li­cans from states in the Mid­west and North­east that have been rav­aged by the drugs.

To help pay for the added spend­ing, the mea­sure would re­tain 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.

McCon­nell has said he in­tends to take up the re­vised bill next week, although it is un­clear if he would try to move ahead if he did not know for sure whether he had the votes to be­gin de­bate — or to ul­ti­mately pass the bill.

In a leg­isla­tive twist, two Repub­li­cans an­nounced plans to of­fer their own health care plan just as McCon­nell re­leased his own.

Sens. Bill Cas­sidy of Louisiana and Lind­sey Gra­ham of South Carolina de­buted their health care pro­posal on CNN mo­ments be­fore McCon­nell briefed leg­isla­tive mem­bers.

In a joint in­ter­view with CNN, Cas­sidy and Gra­ham said that they would take the bil­lions of dol­lars the fed­eral gov­ern­ment now re­ceives in taxes un­der the Af­ford­able Care Act and di­rect that rev­enue to the states.

“We’re go­ing to see which one can get 50 votes,” Gra­ham said. “We’re not un­der­cut­ting him; he’s not un­der­cut­ting us.”

In­for­ma­tion for this ar­ti­cle was con­trib­uted by Erica Werner ,Alan Fram, Ri­cardo Alonso-Zal­divar, Matthew Daly and Kevin Frek­ing of The As­so­ci­ated Press; by Robert Pear and Thomas Ka­plan of

The New York Times; by Sean Sul­li­van, Kelsey Snell and Juliet Eilperin of The Wash­ing­ton Post; and by Frank E. Lock­wood of the Ar­kan­sas Demo­crat-Gazette.

AP/J. SCOTT APPLEWHITE

Repub­li­can Sen. Su­san Collins of Maine said Thurs­day that she op­poses the new Se­nate health care pro­posal mainly be­cause it re­duces spend­ing on Med­i­caid for the poor and dis­abled.

AP/PABLO MARTINEZ MONSIVAIS

Sen. Ted Cruz, R-Texas, said Thurs­day that in­clu­sion of his lan­guage in the pro­posed Se­nate health care bill that would let in­sur­ers sell plans with min­i­mal cov­er­age was “very en­cour­ag­ing.”

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