Pared health bill hits friction
Three in GOP resist it unless House agrees to full redo
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.”
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.
Senate Majority Leader Mitch McConnell leaves the Senate chamber Thursday in Washington after a vote to overhaul the Affordable Care Act.