GOP pledges to re­peal Oba­macare in doubt

Se­nate re­place­ment plan faces back­lash

The Washington Times Daily - - FRONT PAGE - BY TOM HOW­ELL JR.

Repub­li­can lead­ers faced an im­me­di­ate back­lash Thurs­day af­ter re­veal­ing their Oba­macare re­place­ment bill, leav­ing cam­paign vows to re­peal the 2010 health care law in doubt as the Se­nate pushes to­ward a show­down on the cham­ber floor next week.

The bill, an­nounced by Ma­jor­ity Leader Mitch McCon­nell, soft­ens the edges of an ear­lier House ver­sion that Pres­i­dent Trump re­port­edly called “mean.”

The 142-page plan would ex­tend the life of Pres­i­dent Obama’s Med­i­caid ex­pan­sion and of­fer more gen­er­ous sub­si­dies for the poor and those ap­proach­ing re­tire­ment age. It re­moves Oba­macare’s “in­di­vid­ual man­date” and un­winds the health care ex­changes, but it main­tains the 2010 law’s guar­an­tees that let young adults stay on their par­ents’ plans and guar­an­tees cov­er­age de­spite pre-ex­ist­ing con­di­tions.

“Oba­macare is a di­rect at­tack on the mid­dle class, and Amer­i­can fam­i­lies de­serve bet­ter than its fail­ing sta­tus quo — they de­serve bet­ter care,” Mr. McCon­nell said as he went to the Se­nate floor to pub­licly an­nounce the plan, which was drafted

in se­cret.

Democrats uni­formly op­pose the bill, mean­ing Repub­li­cans can­not lose more than two of their 52 mem­bers in a vote.

Yet four have al­ready said they can’t vote for it, as it stands.

Sens. Rand Paul of Ken­tucky, Ron Johnson of Wis­con­sin, Ted Cruz of Texas and Mike Lee of Utah said they op­posed the draft leg­is­la­tion for a va­ri­ety of rea­sons, but they are open to ne­go­ti­a­tion be­fore the bill hits the floor.

Mr. Johnson said he feels rushed, while the others worry that they are turn­ing the di­als on Oba­macare in­stead of ful­fill­ing their pledge to kill it.

“Some­body’s go­ing to have to look at this bill and say we’re go­ing to make it look more like re­peal and less like we’re keep­ing Oba­macare,” Mr. Paul said.

Democrats, mean­while, say the bill is still too much of a re­peal and not enough of Oba­macare. They have said they won’t co­op­er­ate un­til Repub­li­cans agree to keep the ba­sic struc­ture of the 2010 Af­ford­able Care Act, then work on fixes.

“We live in the wealth­i­est coun­try on earth. We’re proud of it as we should be. But surely, we can do bet­ter than what the Repub­li­can health care bill prom­ises,” said Se­nate Mi­nor­ity Leader Charles E. Schumer, New York Demo­crat.

Democrats also have com­plained about the path of the bill, which Mr. McCon­nell wrote and which will head straight to the floor, by­pass­ing the ex­ten­sive com­mit­tee process that char­ac­ter­ized the Oba­macare de­bate.

Mr. McCon­nell promised to wait for a Con­gres­sional Bud­get Of­fice eval­u­a­tion of the bill and said there will be a ro­bust floor de­bate, in­clud­ing amend­ments.

Some rank-and-file Repub­li­cans seemed to like what they saw.

“It’s much bet­ter than Oba­macare. I like this a lot bet­ter than the House bill,” said Sen. David Per­due, Ge­or­gia Repub­li­can.

Others said they needed time to read the whole bill, though they felt the pro­pos­als were trend­ing in the right di­rec­tion.

From the White House, Pres­i­dent Trump said the Se­nate’s health care bill is in good shape but needs a “lit­tle ne­go­ti­a­tion.”

The CBO is ex­pected to re­lease its score next week, de­tail­ing how the bill af­fects fed­eral spend­ing and health care cov­er­age.

Its eval­u­a­tion of the House bill, which passed that cham­ber last month, pro­jected lower costs for most Amer­i­cans but said the poor and those ap­proach­ing re­tire­ment age would see pre­mium hikes. Some 23 mil­lion fewer Amer­i­cans would hold in­sur­ance a decade from now be­cause Med­i­caid’s rolls would be cut and peo­ple would no longer be re­quired by law to pur­chase in­sur­ance.

Sen­a­tors tried to lower costs for the poor and older Amer­i­cans, peg­ging tax cred­its for peo­ple who buy in­sur­ance on their own to their amount of in­come in­stead of just age. That cuts a mid­dle ground be­tween the House plan and Oba­macare.

“For ex­am­ple, the tax cred­its for older folks — peo­ple like me — are now age-ad­justed and in­comead­justed, so some­one who is mak­ing $20,000 a year and 62 years old would be able to af­ford cov­er­age un­der this, where un­der the [House bill] I think it was prob­lem­atic if they could af­ford cov­er­age,” said Sen. Bill Cas­sidy, a Louisiana Repub­li­can and physi­cian.

The plan also goes more slowly in cur­tail­ing Oba­macare’s ex­pan­sion of Med­i­caid, which the House plan froze in 2020. The Se­nate bill would be­gin a grad­ual re­duc­tion in 2021 and re­turn to pre-Oba­macare lev­els in 2024.

To pla­cate fis­cal hawks, the plan would al­low Med­i­caid spend­ing to rise at a slower rate than un­der the House ver­sion, start­ing in 2025.

Repub­li­cans say rein­ing in Med­i­caid spend­ing will force states to fo­cus on those who need it most, though mod­er­ates worry that the cuts will sud­denly pull cov­er­age from needy res­i­dents and crip­ple the fight against opi­oid ad­dic­tion. The fed­eral-state pro­gram cov­ers 1 in 5 Amer­i­cans, about half of U.S. births and two-thirds of nurs­ing home res­i­dents.

A num­ber of Repub­li­cans with­held judg­ment, say­ing they will go back and talk to their gov­er­nors and state health care of­fi­cials and see how the bill af­fects them.

“At first glance, I have se­ri­ous con­cerns about the bill’s im­pact on the Ne­vadans who de­pend on Med­i­caid,” said Sen. Dean Heller, Ne­vada Repub­li­can and a key hold­out.

He is con­sid­ered one of the most vul­ner­a­ble Repub­li­cans on an oth­er­wise fa­vor­able Se­nate elec­toral map next year.

Another swing vote, Sen. Su­san M. Collins of Maine, said the plan has pros and cons that de­serve more scru­tiny.

The bill would let states use Oba­macare’s waiver sys­tem to drop as­pects of the 2010 law, in­clud­ing its list of es­sen­tial ben­e­fits that plans must cover. How­ever, states can­not let in­sur­ers deny peo­ple with pre-ex­ist­ing con­di­tions or charge them more than healthy con­sumers, a con­cept known as “com­mu­nity rat­ing.”

Mr. Cruz and Mr. Lee had been push­ing to scrap more of the reg­u­la­tions on in­sur­ers, not less, and House con­ser­va­tives who will re­visit the fi­nal plan in­sisted on let­ting states waive com­mu­nity rat­ing.

The bill does strip fed­eral fund­ing from Planned Par­ent­hood, the coun­try’s largest net­work of abor­tion clin­ics, mak­ing good on a Repub­li­can cam­paign pledge.

In a boon for in­sur­ers, Repub­li­cans said the bill would main­tain through 2019 the cost-shar­ing pay­ments to in­sur­ance com­pa­nies that cover outof-pocket health care ex­penses of the poor. Mr. Trump has threat­ened to with­hold those pay­ments.

The plan would re­peal Oba­macare’s taxes on health in­sur­ers, med­i­cal de­vice mak­ers and high earn­ers, among others, prompt­ing Democrats to blast it as a wealth trans­fer from the needy to those who are do­ing fine.

“Let’s be very clear: Se­nate Repub­li­cans are pay­ing for tax cuts for the wealthy with Amer­i­can lives,” said Sen. El­iz­a­beth War­ren, Massachusetts Demo­crat.

Mr. Obama also weighed in to de­cry the changes to his sig­na­ture law.

“The Se­nate bill, un­veiled to­day, is not a health care bill. It’s a mas­sive trans­fer of wealth from mid­dle-class and poor fam­i­lies to the rich­est peo­ple in Amer­ica,” Mr. Obama said on Face­book. “It hands enor­mous tax cuts to the rich and to the drug and in­sur­ance in­dus­tries, paid for by cut­ting health care for ev­ery­body else.”

Repub­li­cans have de­scribed their re­peal ef­fort as a mis­sion to rescue Amer­i­cans from a law headed for fail­ure. They point to ris­ing pre­mi­ums and dwin­dling choices, as in­sur­ers pull out of mar­kets.

Sen. John Cornyn, Texas Repub­li­cans, said the cru­elest law­mak­ers of all were Democrats de­fend­ing the “failed ex­per­i­ment” of Oba­macare.

“They may not be will­ing to help, but we will,” he said. “And we will get it done and help the Amer­i­can peo­ple who are be­ing hurt by the fail­ure of Oba­macare to­day.”

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