Repub­li­cans need care­ful bal­ance for health care

McCon­nell’s draft lacks votes to pass

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

Se­nate Repub­li­cans must stamp out a se­ries of fires to keep their Oba­macare re­peal mis­sion alive this week, such as pin­ning down party hold­outs and mas­sag­ing ar­cane bud­get rules to ap­pease pro-life ac­tivists and in­sur­ers.

Repub­li­can mod­er­ates say a pend­ing anal­y­sis by the Con­gres­sional Bud­get Of­fice, set to be re­leased at any mo­ment, will help them de­cide whether they back the draft plan ne­go­ti­ated by Se­nate Ma­jor­ity Leader Mitch McCon­nell, re­ject it or de­mand changes be­fore a planned vote by the time law­mak­ers leave for their July Fourth re­cess.

One of them — Sen. Dean Heller of Ne­vada — made the lead­er­ship’s climb steeper on Fri­day by be­com­ing the fifth Repub­li­can to say he won’t sup­port the plan un­less changes are made. He said his state can­not ab­sorb Med­i­caid cuts in the plan.

“There are some things we’ve said all along that are dial-able, that I think we can hope­fully tweak a lit­tle bit,” Sen. John Thune, South Dakota Repub­li­can and mem­ber of the lead­er­ship team, said af­ter Mr. McCon­nell re­vealed the draft plan to his Repub­li­can troops.

Yet like a Ru­bik’s cube, tweak­ing the plan to suit mod­er­ates will re­draw the de­bate for con­ser­va­tives, who say the plan needs changes to win their sup­port.

Sen. Rand Paul of Ken­tucky is the most en­trenched, say­ing the plan looks too much like Oba­macare. Sen. Ted Cruz of Texas cir­cu­lated a wish list to Repub­li­can col­leagues on how he can get to “yes,” such as al­low­ing in­sur­ers to of­fer plans that don’t com­ply with Oba­macare’s in­sur­ance rules as long as they pro­vide other ones that do.

Sen. Mike Lee of Utah said the Repub­li­can bill “keeps the Democrats’ bro­ken sys­tem in­tact.” He said states should be free to aban­don Oba­macare and adopt their own mod­els of health care. For in­stance, lib­eral states might pur­sue gov­ern­ment-run, sin­gle-payer in­sur­ance and con­ser­va­tive states might em­pha­size tax-ad­van­taged health care sav­ings ac­counts.

An­other Repub­li­can hold­out, Sen. Ron Johnson of Wisconsin, said the Se­nate is rush­ing, so he might re­ject a pro­ce­dural mo­tion to pro­ceed with the bill this week.

“What I’d like to do is slow the process

down, get the in­for­ma­tion, go through the prob­lem­solv­ing process, ac­tu­ally re­duce these pre­mi­ums that have been ar­ti­fi­cially driven up be­cause of Oba­macare man­dates. So, let’s ac­tu­ally fix the prob­lem,” Mr. Johnson told NBC’s “Meet the Press.”

Mr. McCon­nell, Ken­tucky Repub­li­can, can af­ford to lose only two sen­a­tors from his 52-seat ma­jor­ity and still pass a bill un­der bud­get rules that al­low him to avoid a Demo­cratic fil­i­buster, so the plan is al­ready in doubt.

Sen. Su­san M. Collins of Maine is also on the fence, say­ing she is wor­ried that older Amer­i­cans will have to pay more and that she won’t be able to strip out a part of the bill that de­funds Planned Par­ent­hood over its abor­tion prac­tice.

“It makes ab­so­lutely no sense to elim­i­nate fed­eral fund­ing for Planned Par­ent­hood,” Ms. Collins told ABC News, not­ing that fed­eral funds can­not be used di­rectly for abor­tion any­way.

How­ever, axing that part of the bill would dispirit pro-life law­mak­ers in the House who passed their own bill in March and must re­visit the Se­nate’s re­write be­fore Congress puts a bill on Pres­i­dent Trump’s desk.

Mr. Trump con­firmed on Sun­day that he has called the House ver­sion “mean,” though he is cau­tiously op­ti­mistic that Se­nate Repub­li­cans can ap­prove a bill with “heart.”

“Health care is a very, very tough thing to get,” the pres­i­dent said on Fox News. “But I think we’re go­ing to get it. We don’t have too much of a choice, be­cause the al­ter­na­tive is the dead car­cass of Oba­macare.”

Sen. Charles E. Schumer, New York Demo­crat, put the Repub­li­cans’ odds at 50-50. He ar­gued that some Repub­li­cans were wor­ried about rein­ing in Oba­macare’s vast ex­pan­sion of fed­er­ally sub­si­dized health care.

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 than the House plan.

Yet to pla­cate fis­cal hawks, the plan would al­low Med­i­caid spend­ing to rise at a slower rate than in the House ver­sion, start­ing in 2025. Repub­li­cans say rein­ing in Med­i­caid spend­ing would force states to fo­cus on those who need it most, though mod­er­ates worry that the cuts would yank cov­er­age from needy res­i­dents and crip­ple the fight against opi­oid ad­dic­tion.

“The bill is just dev­as­tat­ing. And that’s what’s mak­ing it so hard for them to pass it,” Mr. Schumer told ABC News. He said Democrats will con­tinue to fight any re­peal ef­fort and push for bi­par­ti­san talks on Oba­macare’s wob­bly markets.

Though a wily ne­go­tia­tor, Mr. McCon­nell faces pro­ce­dural headaches, such as fend­ing off po­lit­i­cally painful votes on amend­ments and sat­is­fy­ing the Se­nate’s ref­eree, the par­lia­men­tar­ian, who might strike lan­guage that is not rel­e­vant to the bud­get process.

Se­nate lan­guage bar­ring con­sumers from us­ing tax cred­its for abor­tion might not pass the vet­ting process known as a “Byrd bath,” forc­ing Repub­li­cans to fun­nel the money through an ex­ist­ing fed­eral pro­gram that pro­hibits spend­ing on the pro­ce­dure.

If pro-life lan­guage doesn’t make it into the fi­nal pack­age, “I think that blows the thing to Mars,” said Rep. Trent Franks, Ari­zona Repub­li­can.

Health in­sur­ers are weigh­ing the pros and cons of the draft plan too. They cheered fund­ing for “cost shar­ing” re­im­burse­ments through 2019, the re­peal of a tax on their in­dus­try and a sta­bil­ity fund to help the markets tran­si­tion to a new pro­gram through 2021.

“All of that will help im­me­di­ately to make cov­er­age more af­ford­able, es­pe­cially for young and healthy peo­ple,” said Kris­tine Grow, a spokes­woman for Amer­ica’s Health In­sur­ance Plans, a key in­sur­ers lobby.

Yet in­sur­ers are wor­ried about sweep­ing cuts to Med­i­caid be­cause man­aged care plans rely on re­im­burse­ments from the pro­gram, and the Se­nate draft doesn’t in­clude an in­cen­tive for peo­ple to en­roll and start pay­ing pre­mi­ums be­fore they need med­i­cal care.

The Repub­li­can plan scraps penal­ties tied to Oba­macare’s “in­di­vid­ual man­date” re­quir­ing peo­ple to hold in­sur­ance, and the House ver­sion would im­pose a year­long sur­charge on the pre­mi­ums of peo­ple who ex­pe­ri­ence a lapse in cov­er­age for 63 days or more.

The Se­nate doesn’t in­clude a con­tin­u­ous cov­er­age pro­vi­sion, though Repub­li­can aides said they are try­ing to in­clude one if the par­lia­men­tar­ian will al­low it.

AS­SO­CI­ATED PRESS

Sen. Dean Heller, Ne­vada Repub­li­can, an­nounced Fri­day that he would vote no on his party lead­er­ship’s health care bill un­less changes are made. He said his state could not ab­sorb Med­i­caid cuts in the plan.

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