Still uphill for overhaul

Revised health care bill lacks votes to pass; in a surprise move, two senators offer alternative

What is different

The new draft would lift many of the ACA’s tight regulatory requirements, allowing insurers to offer bare-bones policies without coverage for such services as preventive or mental-health care. It would also direct billions of dollars to help lower- and middle-income Americans buy plans on the private market. However, the draft leaves in place proposed deep cuts to Medicaid. Moderate Republicans remained concerned that the new proposal would make insurance unaffordable for some middle-income Americans and throw millions off the rolls of Medicaid.

Opposition

“This is not what the American people expect of us, and it’s not what they deserve,” said Sen. John McCain, R-Ariz., one of the three GOP senators who said they oppose the new bill. Moderate Sen. Susan Collins of Maine told reporters 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 efforts don’t amount to a full-blown repeal of the law known as Obamacare, also said he was a “no.”

WASHINGTON» Senate Majority Leader Mitch McConnell, R-Ky., on Thursday released a new proposal to overhaul the Affordable Care Act after spending three weeks reworking it to win over wavering lawmakers on the right and in the center.

But within hours, it was clear that Senate leaders still didn’t have the votes to fulfill their longstanding quest to replace former President Barack Obama’s 2010 health care law.

The new draft would lift many of the ACA’s tight regulatory requirements, allowing insurers to offer bare-bones policies without coverage for such services as preventive or mental health care. It would also direct billions of dollars to help lower- and middle-income Americans buy plans on the private market.

However, the draft leaves in place proposed deep cuts to Medicaid — and at least three Republicans quickly stated that they remain opposed, casting doubt on McConnell’s plans to pass the bill next week.

“This is not what the American

people expect of us, and it’s not what they deserve,” said Sen. John McCain,, RAriz., one of the three senators who said they oppose McConnell’s new bill.

The GOP’s continuing push — and continuing struggle — to make good on a campaign promise they began invoking seven years ago to “repeal and replace” Obamacare reflected the peril Republicans face whether they pass a bill or not.

Even as McConnell negotiated with individual members, the outlook for the bill was complicated when Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C., debuted an alternative proposal.

McConnell’s new draft was the result of weeks of negotiations with conservatives and moderates. For those on the right, the plan incorporated a proposal from Sen. Ted Cruz, R-Texas, allowing insurers to offer minimalist policies so long as they also offer more comprehensive ones as well.

Cruz said the provision would give consumers greater choice and lowercost premiums.

For those in the center, the new proposal would spend an additional $70 billion offsetting consumers’ costs — and $45 billion to treat opioid addiction.

Republicans financed these changes by keeping a trio of Obamacare taxes targeting high earners. Lawmakers such as Sen. Bob Corker, R-Tenn., said repealing those taxes would give too much relief to the wealthy at the expense of the poor. These include a 3.8 percent tax on net investment income and a 0.9 percent Medicare payroll tax on individuals making $200,000 a year or couples earning $250,000, along with a tax on insurers with high-paid executives.

The new measure has won Cruz’s backing, but Sen. Rand Paul, R-Ky., another conservative who said the measure still does not do enough to unravel the law also known as Obamacare, remained opposed to voting on the bill, as did two centrists, Sens. Susan Collins, R-Maine, and McCain.

The McConnell plan would allow Americans to pay for premiums with money from tax-exempt health-savings accounts, an idea that many conservatives have pushed — a tax break that primarily would benefit the uppermiddle class. The plan’s proposed rollback of Medicaid expansion under the ACA, as well as a proposal to slow the overall growth of the program starting in 2025, gave a number of Republican moderates pause on Thursday.