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Senate GOP Health Care Bill Faces Crucial Week, And Many Doubts

congress-healthcare

Senate Majority Leader Mitch McConnell has set a deadline of Friday for a final vote on the Senate GOP’s version of health care reform, but it’s looking increasingly unlikely that he’ll get there:

WASHINGTON — Senate Republican leaders scrambled Sunday to rally support for their health care bill as opposition continued to build inside and outside Congress, and as several Republican senators questioned whether it would be approved this week.

President Trump expressed confidence that the bill to repeal the guts of the Affordable Care Act would pass.

“Health care is a very, very tough thing to get,” Mr. Trump said in an interview shown Sunday 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.”

With Democrats solidly opposed to the legislation, Senate Republicans must find the votes from within. They can afford to lose only two votes, but five Republican senators have announced that they cannot support the health care bill as drafted, and others have expressed concerns.

Senate leaders have been trying to lock down Republican votes by funneling money to red states, engineering a special deal for Alaska and arguing that they could insure more people at a lower cost than the House, which passed a repeal bill last month.

But as more analysis of the bill reached state officials, especially in places that expanded Medicaid access under the Affordable Care Act, misgivings grew. Senator Bill Cassidy, a Louisiana Republican and doctor who is considered a critical vote, said he remained undecided. Louisiana, with its high levels of poverty, recently expanded Medicaid.

“There are things in this bill which adversely affect my state, that are peculiar to my state,” Mr. Cassidy said on CBS’s “Face the Nation.”

The bill was drafted in secret, mainly by the Senate majority leader, Mitch McConnell of Kentucky, who unveiled it on Thursday. Mr. McConnell wants a vote this week, before lawmakers take a break for the Fourth of July holiday.

Senator Jerry Moran of Kansas, usually a reliable vote for Senate Republican leaders, said on Fox News, “I just don’t know whether the votes will be there by the end of the week.”

Over the weekend, senators and their aides were poring over the bill, drafting possible amendments, preparing speeches and compiling personal stories from constituents whom they portrayed as either beneficiaries or victims of the Affordable Care Act.

But the bill’s supporters were battling an internal threat: reluctant Republicans. Senator Ron Johnson of Wisconsin said Sunday that “there’s no way we should be voting” on the legislation this week. “No way.”

“I have a hard time believing Wisconsin constituents or even myself will have enough time to properly evaluate this for me to vote for a motion to proceed,” Mr. Johnson said on NBC’s “Meet the Press.”

And Senator Susan Collins, Republican of Maine, said on ABC’s “This Week”: “It’s hard for me to see the bill passing this week, but that’s up to the majority leader. We could well be in all night a couple of nights.”

The U.S. Chamber of Commerce, the National Federation of Independent Business and the National Retail Federation have all said they support the bill. Thomas J. Donohue, the president of the Chamber of Commerce, said it would “help stabilize crumbling insurance markets” and eliminate “ill-conceived Washington mandates and taxes.”

But much of the nation’s $3 trillion health care industry opposes the bill. And Mr. McConnell has done little to woo the health care stakeholders whom Mr. Obama courted assiduously from his first months in office.

The concerns expressed by outside groups also appear to be growing. Top lieutenants in Charles G. and David H. Koch’s political network sharply criticized the legislation over the weekend, saying it was insufficiently conservative and did not do enough to rein in the growth of Medicaid. And a number of Republican governors have joined doctors, hospitals and patient advocacy groups in opposing the bill, in part because of its cuts to Medicaid.

Mr. McConnell has only a few days to wheel, deal and cajole reluctant senators to get behind legislation that has grown less popular with more exposure. He has considerable firepower to win votes by guaranteeing amendments that would address the concerns of individual Republican senators, and by playing on their loyalty to him and to conservative voters still demanding an end to the Affordable Care Act. At the same time, Democrats say, he has striking liabilities. Mr. Trump has endorsed the bill, and Democrats say they will take every opportunity to link the legislation to an unpopular president.

And the Democratic wall of opposition is backed by less partisan voices. Senators are being flooded with appeals like this from the advocacy arm of the American Cancer Society: “Cancer is scary enough. Don’t take away our coverage.”

The American Childhood Cancer Organization, a charitable group formed by parents, is mobilizing a small army of grass-roots lobbyists with the message that the bill, with its deep cuts to Medicaid, “will threaten the lives of children battling cancer.”

The United States Conference of Catholic Bishops said the Senate bill was “unacceptable as written” and would “wreak havoc on low-income families.” At the same time, the bishops said they liked two sections that seek to “prohibit the use of taxpayer funds to pay for abortion or plans that cover it.”

Republicans are finding allies to be few and inconstant. Mr. Trump has said he is “very supportive” of the Senate bill. But that support will be of limited help to Mr. McConnell. Few senators feel loyal to Mr. Trump, whose erratic message has often weakened his influence on Capitol Hill.

After pushing for passage of the House repeal bill, he criticized it as “mean” several weeks later. A spokeswoman, Sarah Huckabee Sanders, said last week that Mr. Trump did not necessarily support cuts to Medicaid, even though his budget and the Senate bill would make such cuts.

Meanwhile, Politico is reporting that an increasing number of Republicans in the Senate are expressing doubts that McConnell’s end of the week timetable is one that can withstand the mounting political pressure it will be facing over the coming week. Several of the Senators who appeared on the morning shows yesterday, for example, were openly calling for more time for members to evaluate the bill and hear from their constituents. One of the strongest voices on that point has been Wisconsin Senator Ron Johnson, who was just re-elected last November after a closely fought race with former Senator Russ Feingold. While it hasn’t adopted the Medicaid expansion offered by the PPACA, Wisconsin is a state that has seen a significant increase in the number of patients enrolled in Medicaid since the passage of the PPACA and the state has benefited from the Federal subsidies that the law provides for Medicaid programs that would be ended by the Senate bill. There’s been no comment yet from McConnell or anyone in the Senate GOP leadership about the timetable for the bill, but with Senators returning to work today from the weekend, it’s likely that they’ll have to say something soon.

As it stands, though, there are at least five Republican Senators who are on record as opposing the bill, with the most recent addition to that list being Dean Heller from Nevada, who is widely seen as being the most vulnerable Republican Senator on the ballot next year. Three of the remaining four consist of some of the most conservative members of the Senate, Rand Paul, Ted Cruz, and Mike Lee. Johnson of Wisconsin, who I made note of above is the fourth. Beyond these five, though, there are at least four other Senators whose support is in doubt for a variety of reasons. These include Rob Portman of Ohio, Shelly Moore Capito of West Virginia, Lisa Murkowski of Alaska, and Susan Collins of Maine. As I noted late last week, this puts McConnell and the Senate GOP leadership in the difficult if not impossible situation of trying to find a way to fix the current version of the bill to appease at least nine Senators, each of whom has their own objections to the bill and each of whom comes to their opposition for different political reasons. As it stands, losing more than two Senators means the bill would go down to defeat, and it seems unlikely that they’ll be able to appease everyone in time for a final vote on Friday.

Further complicating matters for McConnell will be the upcoming report from the Congressional Budget Office, which will release its score of the Senate bill sometime early this week, possibly as early as this afternoon. The key numbers took look for in that report will be the estimate of the number of people who are likely to lose insurance coverage because of the Senate bill and the forecast about what impact the bill is going to have on premiums and deductibles. If the CBO reports on the two versions of the House health care bill — which I wrote about here and here — are any guide, then we’re likely to see the number of uninsured increase and no indication that the Senate bill will do anything to reduce premiums, deductibles, or health care costs. If that’s the case, then it’s likely that will just increase the pressure on Senate leadership to either delay the final vote or go back to the drawing board.

 

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About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway. Follow Doug on Twitter | Facebook

Comments

  1. LaMont says:

    As proven in the House, the “deadline” means little to nothing at all! The GOP will push the deadline back in attempt to get the votes. And they will get them.

    A lot of bamboozled Trump supporters are going to be hurt! Combine that with the resistance movement and we might be able to get some responsible people in office in 2018. And if the US Supreme Court strikes down gerrymandering in Wisconsin – and that is a big IF, it’s game over for the GOP in 2020.

    Like or Dislike: Thumb up 1 Thumb down 2

  2. Bob@Younsgtown says:

    I think I found the answer to the question of what becomes of the “Medical Loss Ratio” that currently is set at 80% by the ACA (below for what is ‘MRL’)

    The Better Care bill being considered this week would allow each state to decide what that ratio will be. Doing that will likely allow insurance companies to increase their profit, beginning 2019 the insurance companies will lobby the state insurance commissions to lower the required ratio of premiums to claims. If nothing else – moving from a fixed ratio to a floating ratio will contribute to the uncertainty of the overall insurance market.

    (MRL is the ratio of actual claims to premiums paid by an insurer. ACA set that ratio at 80% – the Better Care Act eliminates that requirement.)

    Like or Dislike: Thumb up 2 Thumb down 0

  3. MarkedMan says:

    Republicans always end up doing what they are told, especially the so called moderates.

    Like or Dislike: Thumb up 8 Thumb down 0

  4. al-Alameda says:

    @MarkedMan:

    Republicans always end up doing what they are told, especially the so called moderates.

    Exactly, there will be no profiles in courage.

    Does anyone honestly believe that 3 senators – say, Collins, Murkowski, Heller – will stand up and deny McConnell and Trump this one?

    Trump cuckolds all Republicans in his path.

    Like or Dislike: Thumb up 1 Thumb down 0

  5. Scott says:

    I think there should be a healthy skepticism of the possibility of any no votes from the right wing side. There seems to be a lot of kabuki dancing going on. You can tell by the weekend news shows where all the talk is about “concerns” and very little talk about actual BCRA impacts on people. When they are talking about process versus actual policy then you know your are going to get it and get it hard.

    Like or Dislike: Thumb up 8 Thumb down 0

  6. Jen says:

    Sen. Johnson’s op-ed in the NYT is full of the same sort of “let’s allow the free market to work!” nonsense that the GOP has been trying for years. Johnson uses as his example how costs associated with laser eye surgery came down–without noting that it is an elective surgery. Most people with an appendix about to burst aren’t going to say, “nah, I’ll wait until costs come down a bit.”

    I’m baffled that people in such positions of power make such consistently stupid arguments.

    If this goes down in flames, what’s next? The uncertainty has made a mess of the marketplaces in a number of states.

    Like or Dislike: Thumb up 12 Thumb down 0

  7. Daryl's other brother Darryl says:

    They will vote and this hot mess will pass and then it’ll all be the Democrats fault.

    Like or Dislike: Thumb up 6 Thumb down 0

  8. Pete S says:

    At the same time, the bishops said they liked two sections that seek to “prohibit the use of taxpayer funds to pay for abortion or plans that cover it.

    But current law already blocks taxpayer funding for abortions. This is like last week when the president claimed he was bringing in a law to prevent immigrants from collection welfare for 5 years. The law already exists. The Republicans are gathering support for positions even their supporters wouldn’t like if they knew what was coming, by including “new laws” that their supporters will like but which already exist!

    Again, how are we supposed to treat people with respect who can get fooled by these simple cons time and time again?

    Highly-rated. Helpful or Unhelpful: Thumb up 16 Thumb down 1

  9. grumpy realist says:

    And then there’s the standard idiocies.

    The only fate I can hope for these bozos is that they develop brain cancer and lose their health insurance so they can experience exactly what they’re condemning ordinary Americans to.

    Like or Dislike: Thumb up 6 Thumb down 1

  10. Jen says:

    @grumpy realist: That is unreal. The other thing that he fails to mention is that as insurance companies get more and better data, they are able to classify more conditions as preexisting–meaning, without the restrictions, they’ll be able to charge an ever-larger percentage of the population much, much higher amounts.

    For example: when I first got an individual policy, my migraines were excluded from coverage–meaning, no prescription medications were covered, and no hospitalization or ER would have been covered (if needed).

    Since that time, a whole new classification of medications to treat migraines has been developed (triptans, and botox). These are expensive meds, even the generics. They’ve also learned that certain migraines (migraine with aura) increase stroke risk for some patients. So, migraines have gone from a preexisting condition that wasn’t covered (but you could still get insurance in some form) to a pre-ex that can get you turned down for any coverage.

    The same holds true for sleep apnea. Studies have determined links between sleep apnea and heart disease and a bunch of other medical conditions, so now it’s a pre-ex that can get you flat-out denied for coverage. People like Johnson seem to think super-expensive stuff like cancer and diabetes are what get people denied, and other, “minor” preexisting conditions mean your coverage costs more. What they seem to not understand is that as the scale continues to slide downwards, with more and more people who have preexisting conditions that are fairly minor getting bumped out of the insurance system entirely, these folks end up, what, in the high risk pool? It’s insane.

    Like or Dislike: Thumb up 6 Thumb down 0

  11. steve says:

    It will pass. The protests from some senators is just for show. The GOP does not care that much about health care, but it does care about cutting taxes, so they will definitely pass this.

    Steve

    Like or Dislike: Thumb up 3 Thumb down 0

  12. Jen says:

    @Pete S:

    Is it possible this is new?

    or plans that cover it.

    It seems like that could go in a lot of different directions, none of them good.

    Like or Dislike: Thumb up 0 Thumb down 0

  13. Daryl's other brother Darryl says:

    The lies these people are telling in order to sell this bill are awe-inspiring.
    Later today when the CBO score comes out then they will start lying about the CBO.
    Look…if you want to give a tax cut to the rich and screw all the poor and sick and elderly…then at least have the balls to say so. Republicans are such pu$$ies.

    Like or Dislike: Thumb up 2 Thumb down 0

  14. Facebones says:

    @MarkedMan:

    Republicans always end up doing what they are told, especially the so called moderates.

    Yup. No such thing as a moderate republican. Look at McCain or Lindsey Graham. How many times did they “express concerns” about Trump’s comically unqualified cabinet nominees? And how may did they vote against?

    Like or Dislike: Thumb up 5 Thumb down 0

  15. Gustopher says:

    Wasn’t the House bill dead on arrival too? And it passed.

    They are going to cram it through, as fast as possible, with a little bit of theater, and then they will own health care in this country. Yes, most of the provisions don’t kick in until 2021, and lots of things aren’t affected by it, but when your company’s insurance costs go up next year… for a lot of low information voters, it will be TrumpCare.

    Like or Dislike: Thumb up 3 Thumb down 0

  16. Scott says:

    Interesting article in Daily Beast about Senator Shelley Moore Capito of WV and the impact of the BCRA on that state. Besides all the usual facts about numbers of people losing medical coverage there was these nuggets: 10,000 job losses and $1B in GDP.

    I haven’t seen an economic impact statement about the BCRA/AHCA anywhere else. But it seems to me to be an important component to talk about.

    http://www.thedailybeast.com/if-she-votes-for-trumpcare-her-home-state-gets-mauled

    Like or Dislike: Thumb up 1 Thumb down 0

  17. Just 'nutha ig'nint cracker says:

    “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.”

    If the GOP Senators can get Trump to repeat this phrase enough times during the next week, the bill will pass–actually it’ll probably pass anyway, but … . The line is great–probably one of the best Trump’s writers have come up with. I resonates with all of the “he who must not be named at OTBs,” his blunderbuss sock puppets, the Tyrells, Guarnaris, Gavrillos, bills, JKBs, john430s, and (as an additional bonus) a lot of the people whose ACA premiums, deductibles, and copays went up year on year (my premium increased by about 80%, deductible 100%, copays 230%, for example).

    The genius of it is that when these people realize that they got hosed really bad, they will say, “yes, but Obamacare, just like they say “but Hillary now. Trump just has to stay on message.

    Of course, the disadvantage for the GOP is that Trump has to stay on message.

    Like or Dislike: Thumb up 5 Thumb down 0

  18. KM says:


    Senate Majority Leader Mitch McConnell on Monday updated the health care bill he is whipping votes for to penalize people who do not have insurance and wish to purchase it on the exchanges.

    The new bill says that people who have lacked insurance coverage for 63 days or more must wait six months before reentering the marketplace.

    In other words, lose your job and can’t afford COBRA? Penalty! Got a new job but have to wait to sign up longer then 63 days (damn those 90 probationary periods!)? Penalty! Company drops insurance from your benefits? Penalty!

    Add in the fine that’s already part of the bill and they are doing their utmost to punish people for having the gall to be uninsured. This from the party that freaked out over the Obamacare requirements are more then happy to come up with even worse one to insure you never get insurance once you lose it. But hey, at least they’re not *requiring* you to have it amirite? Freedom!

    Like or Dislike: Thumb up 5 Thumb down 0

  19. Sleeping Dog says:

    And while the Senate is at it, it may as well screw small businesses.

    https://www.vox.com/2017/6/25/15871574/senate-bill-association-health-plans

    Like or Dislike: Thumb up 1 Thumb down 0

  20. Daryl's other brother Darryl says:

    The CBO report is out…22 million will lose insurance.

    Like or Dislike: Thumb up 2 Thumb down 0

  21. Daryl's other brother Darryl says:

    @Daryl’s other brother Darryl:
    15 million next year.
    And they are going to be selling insurance plans with $6,000 deductibles to people who make $15,000 a year. Worthless as handles on a basketball.

    Like or Dislike: Thumb up 1 Thumb down 0

  22. Tyrell says:

    @Daryl’s other brother Darryl: I don’t buy these government reports. Their figures on inflation and unemployment during the recession were off. I am not buying them now.
    I am studying, analyzing, and researching the plan.

    Like or Dislike: Thumb up 0 Thumb down 1

  23. Tony W says:

    The United States Conference of Catholic Bishops said the Senate bill was “unacceptable as written” and would “wreak havoc on low-income families.” At the same time, the bishops said they liked two sections that seek to “prohibit the use of taxpayer funds to pay for abortion or plans that cover it.”

    It’s that kind of self-righteous, hypocritical political stance – we care deeply about the plight of poor people as long as they do exactly as we say – that has the Catholics and other religious folks back on their heels today. Rather than treat people like sentient beings capable of making good, moral decisions within a framework, we spell out a few minority-laden evils so that somebody can feel superior to somebody else.

    /soapbox

    Like or Dislike: Thumb up 1 Thumb down 0

  24. Terrye Cravens says:

    I read that Collins and Paul will vote to block the legislation from coming up for a vote. It might happen and it might not. That CBO report was pretty scary.

    Like or Dislike: Thumb up 0 Thumb down 0

  25. Just 'nutha ig'nint cracker says:

    @Tyrell: I am awaiting your analysis of it with breathless anticipation. I’m serious. I want to hear you explain how it will be an improvement.

    Like or Dislike: Thumb up 1 Thumb down 0