(THIS ARTICLE IS COURTESY OF THE ATLANTIC NEWS AGENCY)
What’s Inside Mitch McConnell’s Latest Health-Care Proposal
The revised Senate bill would keep more of Obamacare’s taxes while allowing insurers to wiggle out of its regulations. Will Republicans go for it?
McConnell needs to pick up support from both ends of the ideological spectrum. He can afford only two Republican defections, and at least 10 of his members had come out against the first version of the Better Care Reconciliation Act before McConnell abandoned plans to bring it up for a vote last month. Two of those critics, Senator Susan Collins of Maine in the center and Senator Rand Paul of Kentucky on the right, appear to have hardened in their opposition this week. Collins said it would take “a complete overhaul” to win her support, and Paul has gone on a media tour to rail against the revised proposal, saying that based on what he had heard, it was even worse than the original because it repealed less of Obamacare and included a bigger “bailout” for insurers.
Within hours after the revised draft’s release, both Paul and Collins reiterated their opposition to it an d said they would vote against even bringing it up for debate. As on the final vote, McConnell needs at least 50 Republicans to sign off on the procedural motion, and with Paul and Collins apparently out, he needs every other member of his conference to agree.
McConnell all but ignored complaints from moderates to soften the bill’s deepest and most contentious cuts—a $772 billion reduction in Medicaid spending over a decade, with hundreds of billions in additional cuts in the 10 years after that. The cuts, which include a four-year phase-out of Obamacare’s Medicaid expansion and a change in the program’s growth rate, would not begin until 2020. According to the Washington Post, McConnell told moderates to support the bill with those cuts included because they would never go into effect.
Yet like the entire bill itself, McConnell’s Medicaid bet is a risky one. Senators like Collins, Lisa Murkowski of Alaska, Heller, Portman, and Capito have strongly opposed the cuts to Medicaid and were already frustrated with the secretive, top-down process McConnell has led on the health-care bill. And conservative activists and senators have pointed to the Medicaid changes as one of the few things they like about a proposal that does not truly fulfill their promise to repeal Obamacare. They had already stomached the Senate’s longer lead-time in ending the ACA’s Medicaid expansion, but will they recoil at McConnell’s reported admission that the reforms might not endure at all?
In another blow to Collins and Murkowski, McConnell also retains provisions blocking federal funds from going to Planned Parenthood and banning the use of subsidies to purchase plans that cover abortion. Both senators had criticized those aspects of the original bill, and if both Collins and Paul vote against the legislation as they’ve indicated, Murkowski’s opposition on those grounds could sink it entirely.
While Lee was undecided, Cruz told reporters that he would support the bill as long as his amendment stayed in and no other changes were made. His position appeared to mimic the new stance of conservative activist groups, who have conceded that Republicans can’t fully repeal the Affordable Care Act but in recent days made the adoption of Cruz’s amendment striking at its core regulations their final demand. Even Grover Norquist, the anti-tax activist who has prioritized the repeal of Obamacare’s tax increases, issued a statement signaling he was okay with McConnell’s decision to keep some of them now as long as the leadership committed to getting rid of them in subsequent tax-reform legislation. Norquist told me in an interview last month that keeping the taxes on the wealthy even temporarily was “a bad idea.”
Illustrating McConnell’s challenge in navigating the bill to passage, the changes that Cruz and Lee are demanding could solidify opposition among moderates or lose even more votes among Republicans leery of doing anything that threatens protections for people with preexisting conditions. The health-care industry is aligned against the proposal, which would essentially create separate insurance markets for sick and healthy people. Even the insurance industry’s top lobbying group, America’s Health Insurance Plans, came out in public opposition to the amendment after staying quiet through much of the Senate debate. Whether the Cruz amendment stays in the bill is in doubt. A senior GOP policy staffer said Thursday the provision was put in brackets in the bill text because “the policy is continuing to be worked on as members react to it.” Republicans have asked the Congressional Budget Office to score versions of the bill with and without the Cruz policy, but it’s unclear whether the report released next week will fully assess the amendment.
“If you like Obamacare and you want to repair it, you can,” Graham said on CNN. “If you want to replace it, you can.”
The idea is in line with an earlier proposal from Cassidy and Collins that would have allowed states to choose whether they kept Obamacare or not. That plan went nowhere, but with Republicans nearing a stalemate on health care, the senators are betting that their colleagues will give it another look.