Uphill battle: GOP leaders plan Tuesday health vote
WASHINGTON — Republican leaders pushed toward a Senate vote next Tuesday on resurrecting their nearly flat-lined health care bill. Their uphill drive was further complicated by the ailing GOP Sen. John McCain’s potential absence and a dreary report envisioning that the number of uninsured Americans would soar.
The White House and GOP leaders fished Thursday for ways to win over recalcitrant senators, including an administration proposal to let states use Medicaid funds to help people buy their own private health insurance. But there were no indications they’d ensured the votes needed to even start debating the party’s legislative keystone, a bill scuttling and supplanting President Barack Obama’s health care law.
“Dealing with this issue is what’s right for the country,” said Majority Leader Mitch McConnell, R-Ky. He added, “It was certainly never going to be easy, but we’ve come a long way and I look forward to continuing our work together to finally bring relief.”
As leaders tested revisions that might attract GOP votes, others began comparing the process with the trade-offs they scorned seven years ago as top Democrats pushed Obama’s overhaul.
“It’s almost becoming a bidding process — let’s throw $50 billion here, let’s throw $100 billion there,” said Sen. Bob Corker, R-Tenn. “It’s making me uncomfortable right now. It’s beginning to feel a lot like how Obamacare came together.”
In a blow, the Congressional Budget Office said McConnell’s latest bill would produce 22 million additional uninsured people by 2026 and drive up premiums for many older Americans. Congress’ nonpartisan fiscal analyst also said it would boost typical deductibles — the money people must pay before insurers cover costs — for single people to $13,000 that year, well above the $5,000 they’d be expected to pay under Obama’s statute.
“Many people with low income would not purchase any plan even if it had very low premiums” because of that exorbitant deductible, the budget office said.
That dire outlook resembled one the office released last month on McConnell’s initial bill, which the leader had to withdraw as Republicans rebelled against it.
Thursday’s report seemed unlikely to do much better to help win over balking moderate Republicans upset over millions of voters losing coverage and cuts in Medicaid, the health insurance program for the poor. These included Sens. Lisa Murkowski of Alaska, Susan Collins of Maine, Ohio’s Rob Portman and West Virginian Shelley Moore Capito.
The GOP’s fissures have changed little for months.
Conservatives like Sens. Mike Lee of Utah and Texas’ Ted Cruz want to loosen Obama’s requirements that insurers cover numerous services and cap customers’ costs, and some want to cut spending for Medicaid and other programs. Conservative Rand Paul, R-Ky., is most interested in simply repealing the 2010 law. Moderates want to ease the spending reductions and leave consumer protections in place.
“There’s a handful of folks who clearly have significant reservations” about backing the bill, said Sen. Pat Toomey, R-Pa. “But they haven’t said no. They haven’t said yes either.”
Sen. John Barrasso, R-Wyo., a member of the Senate leadership, said a vote was expected Tuesday afternoon. But senators suggested that might change with the possible long-term absence of McCain, the 80-year-old Arizonan who announced Wednesday he is battling an aggressive brain cancer and was home undergoing treatment.
Nursing a slender 52-48 majority and adamant Democratic opposition, McConnell has been unable to muster the 50 GOP votes he’d need to approve his party’s health care overhaul. Vice President Mike Pence would cast the tiebreaking vote. Without McCain, the bill would fall if just two Republicans vote against it, and more than that have said they’re ready to do so.
Looking for leverage, McConnell and his lieutenants were arguing that Republicans should back the initial procedural vote to begin debate. Should it pass, they reasoned, senators could force votes on any amendments they chose to propose.
In reality, senators were aware that that procedural vote would be viewed as a vote on whatever health care package leaders were pushing, perhaps reflecting changes negotiated with GOP senators. Several senators said leaders still hadn’t decided what that might be.
Asked if senators would know beforehand what they’d be voting on Tuesday, No. 2 Senate GOP leader, John Cornyn of Texas, told reporters, “That’s a luxury we don’t have.”
McConnell presented his reworked bill last week after adding $45 billion to help states combat overdoses of drugs including opioids and $70 billion to help insurers control consumers’ costs. It also retained tax increases Obama placed on wealthier people to help finance his coverage expansion to 20 million additional people.
And it included a Cruz provision, crucial for winning conservatives’ votes, letting insurers sell low-cost policies with minimal coverage. Conservatives say it will reduce premiums, but opponents say it would result in healthy people buying the cheap policies, leaving many with serious medical conditions unable to afford the fuller coverage they need.
Thursday’s budget office report did not estimate the coverage impact of that provision.
WASHINGTON — Americans were never too thrilled with “Obamacare” and they definitely disapprove of Republican alternatives in Congress, so what does the public want to do on health care?
A new poll suggests the country may be shifting left on this core issue, with 62 percent saying it’s the federal government’s responsibility to make sure that all Americans have health care coverage, while 37 percent say it is not.
The survey findings from the Associated Press-NORC Center for Public Affairs Research indicate a change in public attitudes over the past few months, as concerns mounted about GOP legislation estimated to leave tens of millions without coverage.
“Nobody should be without insurance,” said Louise Prieto of Fort Lee, New Jersey, a retiree covered by Medicare. She said she’s most concerned about seniors, children and people with pre-existing medical conditions.
As recently as March, the AP-NORC poll had found Americans more ambivalent about the federal government’s role, with a slim 52 percent majority saying health coverage is a federal responsibility, and 47 percent saying it is not.
The survey didn’t specify how the government might make sure that people have coverage, but a true guarantee entails something like the “Medicare for all” plan that was a rallying cry for Vermont Sen. Bernie Sanders’ presidential campaign last year. And that would involve hard-toswallow tax increases.
“There is a significant increase in people who support universal coverage,” said Robert Blendon of the Harvard T.H. Chan School of Public Health, who tracks opinion trends on health care. “The impact of the debate over dropping coverage looks like it has moved (more) people to feel that the government is responsible for making sure that people have coverage.”
Currently the U.S. has a hybrid system of paying for medical care, with employers, federal and state governments, and individuals sharing responsibility. Government at all levels pays close to half the annual $3 trillion cost, and federal tax breaks support employer-provided coverage.
Employers cover more than 170 million workers, dependents, and retirees. Medicare, the federal government’s flagship health care program, covers about 56 million retirees and disabled people. Medicaid, a federal-state Medicaid partnership, covers more than 70 million low-income people, from newborns, to severely disabled people, to many elderly nursing home residents. About 28 million people remain without coverage although former President Barack Obama’s health care law has brought the uninsured rate to a historic low of about 9 percent.
The latest AP-NORC poll found a familiar partisan split: more than 8 in 10 Democrats said health care is a federal responsibility, compared with 3 in 10 Republicans. Political independents were more closely divided, with 54 percent saying coverage is a federal responsibility and 44 percent saying it is not.
In the poll, Americans didn’t find much to like about the Republican legislation offered in Congress. Overall, only 17 percent thought they and their families would be better off; 37 percent thought they would be worse off.
On specifics, 73 percent opposed giving states the option to let insurers charge some people higher premiums because of their medical history. And 57 percent opposed allowing states to reduce the types of benefits that federal law now requires insurers to cover. Similarly, 64 percent opposed allowing states to permit some health plans to omit coverage for mental health and drug addiction treatment. There was also solid opposition to Medicaid cuts (62 percent) and overwhelming disapproval (78 percent) for allowing insurers to raise premiums for older adults beyond what is currently permitted.
Republicans have argued that allowing states to loosen such insurance rules, particularly for people who let their coverage lapse, would result in lower premiums all around. The poll also found that Americans disapprove of various strategies that the Obama law and the GOP bills rely on to nudge healthy people to buy coverage, from the current tax penalties for those who don’t have insurance, to waiting periods and premium penalties proposed by Republicans.
The poll was conducted as the GOP “repeal and replace” plan floundered in the Senate during the past week. With the sevenyear Republican campaign against the Affordable Care Act now verging on collapse, a strong majority said lawmakers should try to negotiate on health care.
In the poll, 8 in 10 said Republicans should approach Democrats with an offer to negotiate if the current GOP overhaul effort fails, rather than sticking with their own “repeal and replace” campaign of the past seven years. And nearly 9 in 10 said Democrats should take Republicans up on such an offer.
A foundation for common ground seems to be this: Nearly everyone wants changes to the Obama law, while hardly anyone wants to see it abolished without a substitute in place.
Among Democrats, only 22 percent actually want the ACA kept just as it is; 64 percent want it kept but with changes. Among Republicans, 27 percent want immediate repeal, while 54 percent favor repealing the law when a replacement is ready.
The AP-NORC poll of 1,019 adults was conducted July 13-17 using a sample drawn from NORC’s probability-based AmeriSpeak panel, which is designed to be representative of the U.S. population. The margin of sampling error for all respondents is plus or minus 4.1 percentage points.