Sen. Rand Paul (R-Ky.) criticized the health-care bill introduced by Senate Majority Leader Mitch McConnell on June 22. (Alice Li, Libby Casey/The Washington Post)
Four Republican senators from the conservative wing of their party say they oppose the Senate health-care bill as it was introduced by Senate Majority Leader Mitch McConnell on Thursday, which places the effort to overhaul the American health-care system in jeopardy as it heads for an anticipated vote in the Senate next week.
Those senators — Rand Paul of Kentucky, Ted Cruz of Texas, Ron Johnson of Wisconsin and Mike Lee of Utah — announced in a joint statement that while they cannot support the bill as it is currently written, they are open to negotiating changes that could ultimately win their support.
Their opposition is enough to place success of the GOP measure in doubt as McConnell (R-Ky.) can afford to lose only two Republicans and still pass the measure. Separately, moderate Republican senators voiced concerns about the bill, further complicating McConnell’s path to securing the 50 votes needed to get his bill over the finish line, with Vice President Pence standing ready to break a tie.
Still, some expressed doubts about whether GOP senators who came out swiftly and forcefully against the bill were simply posturing in order to try to move it in a more favorable direction when it heads to the Senate floor — likely next week — and eventually claiming credit for reshaping the legislation before a final vote.
“It needs to look more like a repeal of Obamacare rather than that we’re keeping Obamacare,” said Paul. He expressed displeasure that GOP leaders hadn’t done more to undo the insurance subsides created under the Affordable Care Act.
https://dailymotion.com/video/x5rps3fA health-care bill released June 22 by the Senate Republican leadership faces opposition from Democrats as well as four GOP senators, making the proposal’s fate uncertain. (Video: Alice Li, Jorge Ribas, Libby Casey, Bastien Inzaurralde/Photo: Melina Mara/The Washington Post)
For Johnson, the pace at which the bill is advancing was particularly troublesome. “I have a lot of reservations and a lot of concerns,” he said in an interview. “I have a hard time thinking that those things are going to be answered and allayed by the end of next week.”
In a statement, Cruz said the bill ought to “do more to ensure consumers have the freedom to choose among more affordable plans that are tailored for their individual healthcare needs.”
The bill is being moved under arcane budget rules allowing it to be passed with a simple majority. McConnell has little margin for margin for error in a chamber where Republicans hold a 52-48 advantage and no Democrats are expected to vote for the bill. But some Republicans saw the flurry of opposition on Thursday as less a real threat to sink the bill than a way for lawmakers to gain leverage in shaping the final version.
“If anyone actually believes Ted Cruz isn’t going to vote for final passage of this bill, well, I have some rainforest in Arizona to sell you,” John Weaver, a Republican strategist, wrote on Twitter.
Cruz, who is up for reelection in 2018, helped start a heath-care working group that has been huddling for months. Allies have said that Cruz wants and needs to get to yes on the bill, leading some to conclude that he will eventually come around.
It was also unclear whether key moderates who think the bill goes too far in undoing the ACA — the opposite of the complaints from Cruz and other conservatives — will get behind it.
Sen. Susan Collins (R-Maine), who opposes eliminating federal funding for Planned Parenthood as the bill does, said she has “concerns about some of the provisions” she has seen.
en. Dean Heller (R), who is up for reelection in 2018, released a statement saying he has “serious concerns” about the bill’s Medicaid provisions.
Outside the Capitol, the bill also came under attack. American Hospital Association chief executive Rick Pollack said in a statement that the plan “moves in the opposite direction” in terms of providing health coverage, “particularly for our most vulnerable patients.”
“Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance,” Pollack said.
McConnell introduced draft text — crafted behind closed doors among a small circle of lawmakers and aides — of the Senate GOP bill in a private meeting with Republican senators on Thursday morning.
Initial signs indicated the bill could be in trouble if the Kentucky Republican intends to bring it to a vote next week before lawmakers leave Washington for the July 4 recess. According to two Republicans in close contact with Senate GOP leadership granted anonymity to describe private conversations, McConnell is threatening to bring the bill to a vote next week even if he doesn’t have the necessary votes.
But some believe that message is aimed at trying to pressure Republicans to support the bill rather than an absolute commitment — and that the majority leader would end the push if he doesn’t have the votes. A McConnell spokeswoman declined to comment.
“Right now the challenge is how we get to 50,” said Sen. John Thune (R-S.D.), a top McConnell deputy.
The Senate GOP measure dramatically scales back the 2010 ACA that was President Obama’s signature domestic achievement and helped ensure coverage for roughly 20 million Americans through a combination of Medicaid coverage and subsidized private plans.
The 142-page bill would curtail federal Medicaid funding, repeal taxes on the wealthy and eliminate funding for Planned Parenthood as part of an effort to fulfill a seven-year promise to undo Barack Obama’s signature health-care law.
It abolishes two of the law’s central mandates — that individuals must show proof of insurance when filing their taxes, and that firms with 50 workers or more must provide health coverage — while providing less money for moderate and low-income Americans buying insurance on the individual market.
The bill is an attempt to strike a compromise between the ACA and a measure passed by the GOP-controlled House in May. The Senate proposal largely mirrors the measure that passed the House — with some significant differences.
“Republicans believe we have a responsibility to act — and we are,” said McConnell in on speech on the Senate floor. He underscored the taxes and regulations in the ACA that the GOP measure would repeal.
Senate Democrats swiftly protested the bill, criticizing Republicans for crafting it under very secretive conditions and asking for more time to debate and vet the measure than McConnell plans to allow. Minority Leader Charles E. Schumer (D-N.Y.) said Republicans were “turning truth upside down” with their promises of an open amendment process next week.
Many GOPers reserved judgment on the measure as they exited McConnell’s private presentation. In the days leading up to the bill’s release, some Republicans had intensified their complaints about the contours of the emerging bill and the tightly controlled process under which McConnell and only a small handful of aides wrote it.
Sen. Tim Scott (R-S.C.) said the mood in the room Thursday morning made for an “interesting morning, a little tense.” He was one of several Republicans who pushed for the Senate measure to be “more gracious” than the House bill, an aim he feels was satisfied. But Scott predicted there was “a long way to go” before concluding whether it could pass.
Senate leaders plan to move the bill to the floor after receiving an analysis from the nonpartisan Congressional Budget Office, which said Thursday it will do “early next week.” The CBO is expected to release a comprehensive estimate of how many people are expected to lose coverage as a result of the bill and how much it is expected to cost.
The CBO concluded the House bill would leave 23 million more Americans uninsured by 2026 than under current law, while also concluding that premiums would drop overall.
Like the House bill, the Senate measure would make big changes to Medicaid that in effect would reduce federal spending on the program. The Senate measure would cut off expanded Medicaid funding for states more gradually than the House bill by phasing out the higher federal match between 2020 and 2024, but would enact deeper long-term cuts to a program that ]provides health care coverage for 74 million Americans.
It also would eliminate House language aimed at prohibiting federally subsidized health plans from covering abortions, a provision that may run afoul of complex Senate budget rules.
While the House legislation would peg federal insurance subsidies to consumers’ age, the Senate bill would factor in income as well,as the ACA does. But younger people would still get more generous subsidies than they do under current law.
The measure would preserve two of the ACA’s most-popular provisions: insurers could not deny coverage based on preexisting conditions and children may stay on their parents’ plans until the age of 26. Insurers must set prices based on the overall insurance pool rather than charging sicker Americans more.
But the bill would allow states to use an existing ACA program, known as 1332, for states to file waivers with the Centers for Medicare and Medicaid Services to scale back what sort of plans insurers offer. Through these waivers states could eliminate elements of the ACA’s essential health benefits package, which includes preventive and maternity as well as newborn care, along with substance abuse and mental-health treatment. Such changes would make plans cheaper, though they could lead to higher out-of-pocket expenses for consumers.
Insurance subsidies are currently available to Americans earning between 100 percent and 400 percent of the federal poverty level. Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill — but anyone below that line could get the subsidies if they’re not eligible for Medicaid.
In a move that will please the health-care industry, the Senate bill also proposes repealing all the ACA taxes except for its “Cadillac tax” on high-cost health plans in language similar to the House version. Senators had previously toyed with the idea of keeping some of the ACA’s taxes.
It would also eliminate Medicaid reimbursements for Planned Parenthood for one year. Federal law already prevents taxpayer funding to pay for abortions except to save the life of the mother or in the case of rape or incest. But some Republicans want to ban all federal funding for Planned Parenthood, which also provides health services such as birth control and preventive screening.
In a move that is critical to insurers, the Senate measure would continue to fund for two years cost-sharing subsidies that help 7 million Americans with ACA plans. House Republicans have challenged the legality of the $7 billion in subsidies — which help cover consumers’ deductibles and copays — in court, and insurers warned they would have to increase premiums dramatically next year unless the federal government commits to continuing the payments.
Paige Winfield Cunningham, Elise Viebeck, Amy Goldstein and David Weigel contributed to this report.