Pared health bill hits fric­tion

Three in GOP re­sist it un­less House agrees to full redo

Northwest Arkansas Democrat-Gazette - - FRONT PAGE -

WASH­ING­TON — Three Repub­li­can sen­a­tors on Thurs­day threat­ened to hold up health leg­is­la­tion in the Se­nate un­less they got as­sur­ances from House Speaker Paul Ryan that his cham­ber would ne­go­ti­ate a more com­pre­hen­sive re­place­ment to the Af­ford­able Care Act and not vote to make the Se­nate bill law.

Sens. Lind­sey Gra­ham, R-S.C., John Mc­Cain, R-Ariz., and Ron John­son, R-Wis., who col­lec­tively could sink the GOP’s ma­jor­ity in the Se­nate and, there­fore, the so­called skinny mea­sure, is­sued their ul­ti­ma­tum at a Thurs­day news con­fer­ence.

Ryan re­sponded that “the House is will­ing” to con­vene a con­fer­ence com­mit­tee with the Se­nate to that end. But state­ments from Mc­Cain and Gra­ham said his re­sponse was in­suf­fi­cient.

The three sen­a­tors had said at their news con­fer­ence that their vote for the mea­sure would not be used to trig­ger a hasty vote on such leg­is­la­tion by the House be­fore it heads home for re­cess.

Gra­ham said the skinny bill as-is was a “fraud,” “dis­as­ter,” “pig in a poke” and “half-assed” and that pass­ing it would be “the dumb­est thing in his­tory.”

In his re­sponse, Ryan blamed the Se­nate for be­ing un­able to pass any­thing but said that “if mov­ing for­ward re­quires a con­fer­ence com­mit­tee, that is some­thing the House is will­ing to do.”

Many con­ser­va­tives in

both cham­bers ob­ject to the mea­sure that would re­move key in­sur­ance man­dates and make a hand­ful of other changes be­cause it does not go far enough in re­peal­ing the Pa­tient Pro­tec­tion and Af­ford­able Care Act.

The sen­a­tors made their an­nounce­ment a few hours af­ter Se­nate Ma­jor­ity Leader Mitch Mc­Connell, R-Ky., sent an email to his con­fer­ence out­lin­ing the skinny-re­peal mea­sure.

The mea­sure would elim­i­nate the law’s re­quire­ment that Amer­i­cans ob­tain cov­er­age or pay a tax penalty, and sus­pend the man­date that firms em­ploy­ing 50 or more work­ers pro­vide in­sur­ance for at least five years. It also would elim­i­nate funds for pre­ven­tive health care pro­vided un­der the 2010 law and trans­fer the funds Planned Par­ent­hood would re­ceive for one year to com­mu­nity health cen­ters. Fi­nally, it would pro­vide states more flex­i­bil­ity in how they ad­min­is­ter their Med­i­caid pro­grams un­der the law’s 1332 waiver pro­gram.

While the re­vamped health mea­sure is more mod­est than ear­lier ver­sions of the bill, it would still have a ma­jor im­pact on the in­di­vid­ual in­sur­ance mar­ket. Elim­i­nat­ing the law’s in­di­vid­ual man­date could change the makeup of those buy­ing in­sur­ance and cause the pre­mi­ums of those re­main­ing in the sys­tem to rise sig­nif­i­cantly.

Sev­eral Se­nate Repub­li­cans, how­ever, framed the mea­sure as a ve­hi­cle to keep alive their seven-year ef­fort to re­peal the Af­ford­able Care Act.

“My sense is peo­ple aren’t so much fo­cused on the sub­stance as they are this be­ing the life­line to get to a con­fer­ence and ex­pand­ing the bill,” said Sen. Bob Corker, R-Tenn.

And Sen. Rob Port­man, R-Ohio, tweeted, “I will sup­port leg­is­la­tion to move this process to a House-Se­nate con­fer­ence be­cause I be­lieve we need to re­peal and re­place Oba­macare.”

And while Se­nate Repub­li­cans across the po­lit­i­cal spec­trum de­scribed the lat­est pro­posal as a way to sus­tain the roll­back ef­fort, the prospect of an im­me­di­ate up-or-down vote in the House raised alarms.

A GOP deputy whip who spoke on the con­di­tion of anonymity to dis­cuss in­ter­nal de­lib­er­a­tions said there was a def­i­nite pos­si­bil­ity that the House would pass any Se­nate bill in­tact. But the mem­ber said hard-line con­ser­va­tives could balk, and send the bill to con­fer­ence.

As Se­nate Repub­li­cans sought to move their plan closer to pas­sage, House Repub­li­can lead­ers in­structed their mem­bers not to leave town for their month­long sum­mer re­cess just yet.

“Mem­bers are ad­vised that — pend­ing Se­nate ac­tion on health­care — the House sched­ule is sub­ject to change. All Mem­bers should re­main flex­i­ble in their travel plans over the next few days,” said the of­fice of House Ma­jor­ity Leader Kevin Mc­Carthy, R-Calif. His an­nounce­ment left open the pos­si­bil­ity of a vote to cre­ate a con­fer­ence com­mit­tee — or on the skinny re­peal it­self.

But key House con­ser­va­tives said they would not back the skinny re­peal if it came over from the Se­nate in its cur­rent form.

Rep. Mark Mead­ows, R- N. C., chair­man of the House Free­dom Cau­cus, said he wouldn’t vote for the mea­sure and didn’t think other con­ser­va­tives would, ei­ther.

“My nose would say that there’s enough that it would lack the sup­port,” he told re­porters.

In two votes within 24 hours of each other, the Se­nate re­jected dif­fer­ing approaches to rewrit­ing the land­mark 2010 law.

On Wed­nes­day, the Se­nate re­jected a pro­posal that would have re­pealed ma­jor parts of the Af­ford­able Care Act out­right, with seven Repub­li­cans join­ing all of the cham­ber’s Democrats in op­po­si­tion.

The day be­fore, a re­place­ment bill that would have weak­ened the law’s in­sur­ance rules and pro­vided more money to help Med­i­caid re­cip­i­ents tran­si­tion to pri­vate in­sur­ance failed by a slightly larger mar­gin.

Speak­ing on the Se­nate floor Thurs­day, Mc­Connell em­pha­sized that the votes this week would not re­verse the law even if they cul­mi­nate

in the pas­sage of a bill. The votes were ex­pected to be held through the night and into this morn­ing.

“One phase of that process will end when the Se­nate con­cludes vot­ing this week, but it will not sig­nal the end of our work. Not yet,” Mc­Connell said.

While Mc­Connell pre­dicted there would be an all-night marathon of votes, Democrats have de­cided to save their po­lit­i­cal am­mu­ni­tion un­til Repub­li­cans re­veal the sub­stance of the skinny re­peal that they have been craft­ing.

Se­nate Mi­nor­ity Leader Charles Schumer, D-N.Y., said in a Se­nate floor speech that Democrats would of­fer no more amend­ments un­til that point, so Repub­li­cans could not claim that their fi­nal bill was the prod­uct of ex­ten­sive Se­nate de­lib­er­a­tions.

Schumer said that if the skinny- re­peal plan passes, the Se­nate should then be pre­pared for “nu­mer­ous” Demo­cratic amend­ments, which could po­ten­tially force Repub­li­cans into po­lit­i­cally tough votes.

With the idea of a scaled­back bill emerg­ing as the most likely out­come of this week’s votes, the pro­posal now faces in­creased scru­tiny.

Se­nate Democrats an­nounced late Wed­nes­day af­ter­noon that a pre­lim­i­nary Con­gres­sional Bud­get Of­fice es­ti­mate found that 16 mil­lion peo­ple would lose cov­er­age and that pre­mi­ums would rise 20 per­cent if Repub­li­cans en­acted a hand­ful of the poli­cies floated for the pared-down re­peal bill. The anal­y­sis was based on the as­sump­tion that the GOP wants to re­peal the in­di­vid­ual and em­ployer man­dates, end a 2.3 per­cent tax on med­i­cal de­vice man­u­fac­tur­ers, ban fund­ing for Planned Par­ent­hood and re­peal funds for pre­ven­tive health care.

In a sign of how the prospect of an in­crease in the unin­sured rate con­tin­ues to worry gov­er­nors, a bi­par­ti­san group of 10 of them — in­clud­ing Repub­li­cans Brian San­doval of Ne­vada and John Ka­sich of Ohio — urged Se­nate lead­ers late Wed­nes­day to work to­gether with gov­er­nors in de­vel­op­ing a new plan and to re­ject a skinny re­peal, which they said “is ex­pected to ac­cel­er­ate health plans leav­ing the in­di­vid­ual mar­ket, in­crease pre­mi­ums, and re­sult in fewer Amer­i­cans hav­ing ac­cess to in­sur­ance.”

MAR­KET JIT­TERS

Mean­while, the on­go­ing un­cer­tainty on Capi­tol Hill sent jit­ters through the in­sur­ance in­dus­try.

Joseph Swedish, the chief ex­ec­u­tive of An­them — the na­tion’s sec­ond-largest health in­surer — said on a con­fer­ence call to re­view sec­ond-quar­ter earn­ings that the com­pany is re­assess­ing its par­tic­i­pa­tion in Af­ford­able Care Act mar­ket­places for next year. An­them has de­cided to largely with­draw from the mar­kets in three of the 14 states it par­tic­i­pates in, and he said it may stop par­tic­i­pat­ing else­where un­less the mar­kets seem sta­ble.

The Blue Cross Blue Shield As­so­ci­a­tion warned that even the skinny re­peal Repub­li­cans now en­vi­sion could un­der­mine the in­di­vid­ual-in­sur­ance mar­ket be­cause it would elim­i­nate the in­di­vid­ual man­date. The mea­sure, which re­mains sub­ject to ne­go­ti­a­tion, also would likely elim­i­nate the Af­ford­able Care Act’s re­quire­ment that em­ploy­ers with 50 work­ers or more pro­vide health cov­er­age, and a med­i­cal de­vice tax that gen­er­ates $19.6 bil­lion in fed­eral rev­enue over a decade.

And Amer­ica’s Health In­sur­ance Plans, a ma­jor in­sur­ance trade as­so­ci­a­tion, weighed in with a let­ter Thurs­day say­ing it op­poses “tar­geted pro­pos­als that would elim­i­nate key el­e­ments of cur­rent law with­out new sta­bi­liz­ing so­lu­tions.”

Still, the stock mar­ket ap­peared sta­ble, with health care com­pa­nies in the Stan­dard & Poor’s 500 In­dex up 16 per­cent this year, beat­ing the over­all mar­ket’s 11 per­cent gain. In­sur­ers, the com­pa­nies tied most closely to the Af­ford­able Care Act, are up even more — at 23 per­cent.

In­for­ma­tion for this ar­ti­cle was contributed by Juliet Eilperin, Kelsey Snell, Sean Sul­li­van, Dino Gran­doni, Amy Gold­stein, David Weigel, Mike DeBonis and Tory Newmyer of The Wash­ing­ton Post; by Erica Werner and Alan Fram of The As­so­ci­ated Press; and by Laura Lit­van, Arit John and Zachary Tracer of Bloomberg News.

AP/J. SCOTT APPLEWHITE

Se­nate Ma­jor­ity Leader Mitch Mc­Connell leaves the Se­nate cham­ber Thurs­day in Wash­ing­ton af­ter a vote to over­haul the Af­ford­able Care Act.

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