Still up­hill for over­haul

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

The Denver Post - - FRONT PAGE - By Sean Sul­li­van, Kelsey Snell and Juliet Eilperin

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.

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