Senate Republicans Release Health Care Plan That Could Already Be Dead On Arrival
Senate Republicans released their proposed health care plan this morning, but it could already be doomed.
After weeks of behind the scenes, largely secret, meetings between a handful of Senators, Senate Republican unveiled the plan they intend to have the Senate debate and vote on before the July 4th recess:
WASHINGTON — Senate Republicans, who have promised a repeal of the Affordable Care Act for seven years, took a major step on Thursday toward that goal, unveiling a bill to cut Medicaid deeply and end the health law’s mandate that most Americans have health insurance.
The 142-page bill would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment.
The Senate bill — once promised as a top-to-bottom revamp of the health bill passed by the House last month — instead maintains its structure, with modest adjustments. The Senate version is, in some respects, more moderate than the House bill, offering more financial assistance to some lower-income people to help them defray the rapidly rising cost of private health insurance.
But the Senate measure, like the House bill, would phase out the extra money that the federal government has provided to states as an incentive to expand eligibility for Medicaid. And like the House measure, it would put the entire Medicaid program on a budget, ending the open-ended entitlement that now exists.
It would also repeal virtually all the tax increases imposed by the Affordable Care Act to pay for itself, in effect handing a broad tax cut to the affluent, paid for by billions of dollars sliced from Medicaid, a health care program that serves one in five Americans, not only the poor but almost two-thirds of those in nursing homes. The bill, drafted in secret, is likely to come to the Senate floor next week, and could come to a vote after 20 hours of debate.
If it passes, President Trump and the Republican Congress would be on the edge of a major overhaul of the American health care system — one-sixth of the nation’s economy.
The premise of the bill, repeated almost daily in some form or other by its chief author, the Senate majority leader, Mitch McConnell of Kentucky, is that “Obamacare is collapsing around us, and the American people are desperately searching for relief.”
Mr. Trump shares that view, and the Senate bill, if adopted, would move the president a great distance closer to being able to boast about final passage of a marquee piece of legislation, a feat he has so far been unable to accomplish.
Democrats and some insurers blame the Republicans and Mr. Trump for sabotaging the law, in part by threatening to withhold subsidies used to help pay for deductibles and co-payments for millions of poor people covered by the law.
In the Senate, Democrats are determined to defend a law that has provided coverage to 20 million people and is a pillar of former President Barack Obama’s legacy. The debate over the repeal bill is shaping up as a titanic political clash, which could have major implications for both parties, affecting their electoral prospects for years to come.
Mr. McConnell faces a great challenge in amassing the votes to win Senate approval of the bill, which Republicans are trying to pass using special budget rules that will allow them to avoid a Democratic filibuster. But with only 52 seats, Mr. McConnell can afford to lose only two Republicans, with Vice President Mike Pence breaking the tie. He may have already lost one — Senator Rand Paul, Republican of Kentucky, has indicated repeatedly that the bill is too liberal for him.
Democrats are unified in opposing the repeal efforts, and they have already assailed Republicans for the work they have done so far, criticizing them for putting the bill together without a single public hearing or bill-drafting session.
In the short term, the possible electoral consequences are more muted in the Senate than in the House, as only two of the Senate Republicans who face re-election next year, Dean Heller of Nevada and Jeff Flake of Arizona, are seen as vulnerable.
But Republican leaders still must contend with internal divisions that will be difficult to overcome. Numerous Republican senators from states that expanded Medicaid are concerned about how a rollback of the program could affect their constituents, and they face pressure from governors back home.
Some senators have concerns based on other issues specific to their states, including the opioid epidemic that has battered states like West Virginia and Ohio. And some of the Senate’s most conservative members could resist a bill that they view as not going far enough in dismantling the Affordable Care Act.
Senators will not have long to sort out their differences. Mr. McConnell wants to hold a vote before lawmakers return home for the Fourth of July recess. If the repeal bill is still looming over the Senate, Republicans are certain to face intense pressure from constituents who wish to see the Affordable Care Act remain in place.
The short time frame in which McConnell is seeking to get Senate action on the proposal raises a number of issues that could make it hard for McConnell to get his wish First, it’s unclear if there will be sufficient time for the Congressional Budget Office to review and score the proposal. If there isn’t then Senate Republicans won’t be able to vote on the proposal until the CBO has released its report. For its part, the CBO stated via its Twitter account that it is aiming to release a report on the Senate by “early next week.” If the report is released and it’s anything similar to the CBO’s assessment of the proposal that passed the House, which the CBO said would cause 23 million fewer people to have insurance coverage while having only a modest impact on premiums, then the will is most likely dead. Second, four conservative Senators who were elected on the promise that they would vote to “repeal Obamacare” — Rand Paul, Ted Cruz, Mike Lee, and Ron Johnson — have signed a letter stating their opposition to the bill in its current form and have called on McConnell to make changes to the bill that would move it further to the right. Also of concern for McConnell are Republicans who represent states that accepted the PPACA’s expansion of Medicaid along with the Federal money that comes with it. The Senate bill, if it became law, would eliminate that Federal assistance and potentially leave a number of states with large holes in the budget. As Amber Phillips notes, back in March four Republicans — Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Lisa Murkowski of Alaska, and Cory Gardner of Colorado — signed on to a letter to McConnell that said they would oppose any bill that ended the PPACA’s Medicaid expansion. That brings us to a total of eight Republican Senators who are at this point unwilling to sign on to McConnell’s plan. NBC’s Chuck Todd, meanwhile, reported within an hour after the bill was made public that at least three other Senators will announce opposition to the plan at some point today. Todd doesn’t make clear who those Senators might be, but reports have indicated that both Susan Collins and Lisa Murkowski could end up opposing the bill’s proposed elimination of Federal funding for Planned Parenthood, which would apparently include a bar on the use of Federal funds via Medicaid that cover routine services provided by Planned Parenthood clinics. Also of concern for Senate GOP leadership should be Senators Dean Heller of Nevada and Jeff Flake of Arizona who are considered to be the two Republican Senators whose seats are vulnerable in 2018. That brings us to the simple issue of math, With Democrats likely united in opposition to the plan, McConnell can only afford to lose two Senators on a final vote to get the bill through the Senate. Anything more than that, and the bill would fail to pass on even a 50-50 with Vice-President Pence providing the tie-breaking vote.
With all of this taken into account, the time between now and the scheduled Senate recess will likely be quite similar to the battle that we saw unfold in the House of Representatives over the passage of the House GOP’s proposed legislation, which it labeled the American Health Care Act. On one side there will be the bloc of conservative Senators led by Rand Paul trying to force concessions out of McConnell and the Senate leadership that would push the bill further to the right. On the other side will be Senators such as Portman, Capito, and Gardner who object to anything that appears to include the elimination of the PPACA’s Medicaid expansion provisions. Also included in that mix are relative moderates such as Mark Kirk, Susan Collins, Dean Heller, and Jeff Flake, each of whom could end up opposing the bill for their own individual reasons. With that many people inside his own caucus threatening the wreck his plans, McConnell will be hard-pressed to get the Senate to a final vote before the close of business on July 3rd. After that, the Senate isn’t scheduled to reconvene until July 7th, a period that could end up proving fatal to McConell’s plan as opponents are given more and more time to organize opposition and coordinate efforts to stop the Senate GOP from passing the bill at all. Taking all of that into account, the bill introduced today could end up being pronounced ‘dead on arrival’ even before people finish digesting the impact it could have on one-sixth of the American economy.
In any case, for those interested, here’s the Senate’s proposed bill:
Senate Health Care Bill by Doug Mataconis on Scribd
I suspect Jon Chait is correct on how the next week will go:
“If the bill passes — which, at this early moment in the lightning-fast process, seems quite likely — it will be because McConnell took advantage of the anchoring effect. The starting point is a brutal, cruel piece of legislation with massively unpopular features. (The public overwhelmingly opposes Medicaid cuts, which are the bill’s most pronounced effect.) It will reportedly draw public opposition from at least some holdout Republicans. At that point, the holdouts will be able to wrest relatively small concessions from McConnell.
These concessions will have outsized political impact. They will be new and newsy, and reporters will be drawn from the old story — the outlines of the bill — toward the newer developments. The major coverage of the bill will likely focus on changes in the proposed law that make coverage more affordable. The overall law will still make coverage less affordable overall, but that large fact will remain in the background.”
Fewer people will have coverage, and those that have it will pay more.
Pre-existing conditions will not be protected.
This bill is diametrically opposed to Don the Con’s campaign pledges, and to several years of Republican claims that they can do better than Obamacare.
Let’s be honest…this is not a health care bill…it is a tax cut for the rich. In that way, and only in that way, is it successful legislation.
You’d never know these putzes had six/seven years to prepare for this.
It’s too bad Ayotte was voted out last year. Then we could pretend there’s yet another Republican who might not vote for the bill.
(They’re all going to vote for it..)
@James Pearce:
“(They’re all going to vote for it..)”
No, there will be 2 Republicans who will be granted leave to vote against it, leaving 50 Senators voting for, plus Pence to break the tie. If I were betting on whom, I would choose Paul and Collins.
(They’re all going to vote for it..)
So Republican Senators Rand Paul, Ted Cruz, Mike Lee, and Ron Johnson and others are just a bunch of sneaky weasels who will pander to a constituency yet in the end succumb to whatever political flotsam and jetsam they can salvage from the shipwreck of the SS Trump.
Seeing how easy it was for opposing House Republicans to be bought and pressured, I think this bill will pass. McConnell is miles more talented than Ryan in legislative ability.
The key thing for Ds is to fight like hell now, lay down some clear markers of principle and run against republicans on healthcare starting now.
Like I said in previous thread, the message should be:
1) Healthcare is a right.
2) Promise to repeal the Republican bill and reinstate the ACA.
Also focus on the tax cut for wealthy line.
I think Heller will be one allowed to vote against it, he is running in 2018 in a state that I think Trump lost. The question is how much he will be allowed to attack it publicly.
Is there an online casino somewhere that could take bets about which 2 Republican Senators will be the “no” votes?
@Scott: My feeling is that if the average American isn’t interested enough to stand up on his own hind feet and fight for his own health care, he shouldn’t expect the Democratic Party to do it for him.
I’m tired of trying to explain to people that they’re voting for their own destruction and that we all have to help each other out. Maybe we DO need to pull a Kansas, cut taxes, cut Medicare/Medicaid, have rural hospitals close (with the expected effects on the local economy), have nursing homes close and have people suddenly get phone calls saying “come and pick up your senile mom; there’s no more money to pay to take care of her.”
@grumpy realist:
Personal opinion? They don’t really believe that they’re going to lose it.
Truthfully, either of these bills passing – while undeniably painful for broad swaths of the population – might just be the best political gift that Democrats have gotten in years. I’m of the opinion now that these people actually need to get kicked in the teeth – good and hard – by the consequences of their choices. Nothing else is going to get them to move.
Our role is to vote against them, and publicly be seen to do so. It’ll allow us to legitimately say “Don’t blame us – they’r the ones that f’ked you.”
The 2018 attack ads pretty much write themselves.
@Daryl’s other brother Darryl:
To quote Gomer Pyle, “Surprise, surprise, surprise!”
@Daryl’s other brother Darryl:
Bingo. Imagine the anger that will result from these nimrod voters being screwed to the floorboards by the Republicans that they voted for, while people like Reynolds and myself walk away with tax cuts equivalent to several multiples of their annual earnings (for the ones who aren’t already unemployed anyway …)
The attack ads just write themselves …
@Moosebreath:
Who will grant them this leave?
@Mr. Bluster:
That’s one way to put it. I mean, all 4 of those guys want to repeal ACA. Paul and Cruz also want to run for president.
They’re going to vote to keep ACA intact? I don’t think so.
@HarvardLaw92: I’ve read that it’s engineered to have most of its worst provisions to take effect after 2020 ( http://www.cnn.com/2017/06/22/politics/senate-health-care-bill/index.html ). They realize that it is a horrible bill but are trying to make it as difficult as possible for the democrats to run on it, and doing the most they can to be able to paint the democrats as taking the blame in the future.
@HarvardLaw92: Just read that the investment tax repeal is retroactive to end of 2016.
They are not even trying.
And has been pointed out elsewhere, that this bill does not even solve the imaginary problem of “failing exchanges”. Tax cuts as the expense of the poor, elderly, disabled.
@grumpy realist:
Regardless of what they think of the undeserving, I would hope Democrats will run on these principles because they believe them. If they lose, they lose. There is no point to winning if you don’t know what you are going to do with your win.
Allow states to drop maternity coverage?
http://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world
Doesn’t sound like a good move to me.
@Scott: Oh, I’m firmly in the people-deserve-healthcare camp. I also think that if you’re not willing to be a part of the community, contribute, listen to the doctors nagging you to exercise and eat your veggies, and keep whining about government mandates to Have Insurance, than no, I don’t think the Democrats should be trying to rescue you from the consequences of your bad choices.
You don’t want health insurance? Fine. But public hospitals shouldn’t be on the hook to provide you with free care, then. Go find your own charity elsewhere.
Well the current bill won’t kill enough people.
It still has the coverage mandate but lacks the purchase mandate. That basically means a death spiral for the private insurance market. You can’t have your cake and eat it too.
@James Pearce:
“Who will grant them this leave?”
Mitch McConnell, who else?
Its clear the difference between a Democrat and a Republican is the Dem will give a starving man a fish, while the Republican will charge him for it.
@HarvardLaw92:
Only if they figure it out. There’s a massive Conservative Entertainment Complex out there to prevent that happening.
This toxic bill is far from dead.
Democrats need completely unified opposition and at least 3 Republicans to join them, AND unless a few Republican senators other than Cruz, Lee, and Johnson are expressing dissatisfaction with the bill, it’s going to be even worse than imagined.
It was difficult to watch the ADAPT group protest at Sen. McConnell’s office today. Stay classy Republicans
I also think this bill will pass; the iron rule of moderate republicans will kick in and they will all fold; after making sure everyone knows they are “concerned”.
I can only hope that CA and NY and the various blue states can save their citizens from this bill and provide funding streams and programs that work. CA alone is more of an economic powerhouse than France so I don’t think this hope is a pie in the sky fantasy.
As for the red states? I give up. Close your rural hospitals. Close your nursing homes. It’s on you now. I realize many decent people will be terribly harmed but I’m starting to realize you cannot be saved.
Perhaps like Kansas’s tax cutting experiment this can be a health care experiment writ large. Lets see how states with hospitals serving rural communities do versus states without.
But as stated above nothing will reach these people until they feel the pain; no argument, no reasoning, nothing will change their minds until they personally are affected.
I gotta say. They really are selfish people.
@MikeSJ:
We’ll become a nation where people have to choose (even more than they do already) between “family, friends, and home” and “continued survival.” And those who can’t afford to move? They’re as good as dead already.
Astonishing that we’re even having this debate in the wealthiest and most powerful nation in all human history. Astonishing, and abominable.
Do you know what I find reassuring about this?
Nothing.
Sucks to be poor or sick in America. But, if this is what we have to do to clean some low-income, low-information, rural, Republican voters off the rolls, then I guess this is what we have to do. Blue states and blue cities will do what they can to blunt the harm to their residents.
I’ve been trying so hard to be a less spiteful person, meditating daily, and trying to understand others, but the Republicans make it so easy to be spiteful.
Sometimes the tree of liberty has to be fertilized with dead people, or something, I guess.
The whole mess is so utterly depressing. This opinion piece in the NYT shows what will likely happen to the uninsured but employed: they’ll find a way to ping the worker’s comp system. Why employers in this country aren’t screaming for universal coverage, I will never, ever understand.
@Gustopher:
I don’t think it’s even that simple. There are a lot of older people with $1-5 million in savings who are in danger of losing the whole wad because of a health-related incident before Medicare kicks in.
@Mr. Bluster: You’re just noticing this now?
@Tony W:
Even Medicare won’t necessarily save you, according to the Kaiser Family Foundation:
So even if you make it to 65, there will be 1) less money to go around; and 2) higher health care costs to take care of.
Say goodbye to your retirement fund!
(Which doesn’t matter because you should work until you’re 900 years old anyway.)
The GOP is now the party of Satan’s useful idiots.
Poison, pollution, pain and punishment for profit. Energy sources from the depths of Hell.
Save the fetus to starve the child.
Turned a madman loose on the world stage.
Jesus weeps.
@Jen:
Because they’ll still have to pay part of the freight in the form of corporate tax increases and reduced compensations to officers. It’s all about whose wallet the money looks better in–always has been, always will be.
@drj: Indeed. We have the means to move to Europe or another civilized nation elsewhere, but I worry about the family and friends we’re leaving behind.
We will see a refugee crisis – red staters migrating to blue states to stay alive, and monied blue-state residents migrating to 1st world countries.
Make America Great Again, indeed.
@Tony W:
Blue states can start a medical tourism fad that will quickly fund whatever programs are needed. Think about it, it would be a great way to undercut red state’s budgets / economy and since Trumpcare will limit insurance and legal liabilities, you’re looking at some nice revenue streams. Go local hospitals in for a small kickback and referrals. Add in a small travel subsidy that you’d easily recoup via local spending, blue states could market themselves as “We’ll help you get better! Come for the treatment, stay for the healthcare!”
Democrats spent all their political capital to get sweeping healthcare reform, and what did it get them?
The hard left wasn’t happy because it wasn’t a Canadian or European single payer system. (Never mind that that wasn’t going to happen when you need the votes of people like Joe Lieberman and Ben Nelson and Max Baucus to break a filibuster.)
The right wasn’t happy because SOCIALISM! (Defined here as subsidies to insurance companies.)
Dems tried to incorporate Republican ideas, like a personal mandate. (Go google the phrase “skin in the game.”) Got accused of being sellout neo-liberals by the left wing base.
This cost the democrats their House majority and took away their senate super-majority.
And now, as additional thanks, all those rural, red staters this was meant to help just elected Trump and the Republicans who are now gleefully taking away their health care to fund tax cuts for the super rich.
If I was a Democratic congress person, I’d just say screw it. You’re on your own. Get those GoFundMe accounts ready to pay for your illnesses, We tried to get people health care and all it got us was a ton of grief from thankless, stupid people.
And if 80K Trump voters in PA, MI, and WI get sick and die before 2020, oh well.
@Facebones :
Sometimes you have to let little Johnny touch the stove before they believe fire = ouch. If it means they loose all the skin on their hand in the lesson, well no skin off your nose, right? Nature at work.
My extremely pro-Trump aunt is on a transplant list. This legislation *will* kill her and she knows it. She’s freaking out now that it’s brutally apparent Republicans want to fellate the rich instead of keeping the poor alive. I’ve stopped taking her teary calls because frankly there’s nothing I can do. She’s not interested in moving to a blue state, is totally behind Trump’s agenda and thinks MAGA is more important some people’s (ie minorities) welfare or freedom. Congrats aunty, that someone just because you. There will be many more like her that could have been saved if they weren’t so dead set on voting themselves into a grave. We’re going to run out of tears before we run out of coffins.
@Jen:
You and me both.
Don’t companies want to get out of the health insurance benefit business? with a Single Payer national plan, companies would then be free to compete on other benefits. And individuals would be able to change employment without having to worry about maintaining coverage.
Implement a new payroll tax – that, similar to Social Security and Medicare, the employee and employer share equally, and those proceeds would go to a national health insurance fund, with each person in America receiving a voucher with which to purchase the national health insurance policy from any private insurance company. Also, allow the insurance company a capped ‘profit’ of 4-5% on the sale of each policy. If people want additional coverage they would be free to purchase excess coverage in the private markets.
Countries like Switzerland do this – we, evidently, are incapable of getting there. We prefer high costs, inefficiency, and millions of uninsured.
I’m about 80% of the way with Grumpy and Facebones: at what point do people wake up and realize what we’re in danger of losing? I’ve got family in Canada, the UK and Australia, and they never cease to be amazed at how passive American voters are. The parliament buildings would burn like Grenfell if those countries’ politicians tried even a fraction of the crap McConnell and Ryan presented. A cousin has said for years to me that Americans are so caught up in our mythology we’re losing touch with reality, that slogans are the only thing that matter. I don’t want to think he’s right – I’m not really fond of that particular cousin.
@Not the IT Dept.: He’s right. MAGA trumped any actually discussion of policy. We’ve been ruled by sound bites since at least the ’80’s,
Sad thing is that these people will still vote Republican, I mean just look at Kansas. Brownback’s tax cuts crippled them and yet the GOP still controls the state legislature.
I hate to say it, but things will only get better when these boomers are dead and gone and milliennials become the majority.
@Tony W: The more interesting thing to me is the number of articles that I read with titles like “20 Countries Where You Can Live Comfortably on $X (usually under 2K) a Month.” Moving to a foreign country isn’t just for the rich anymore.
@al-Alameda: I feel your pain and agree with your solution, but the owners of capital are not any more likely to be rational actors than people who would vote for Trump. A friend of mine was noting that the driving force in decision making among many people amounts to “what will benefit me now,”
@Moosebreath:
If this holds true (not a definite thing, since the Golden Rule of Republican politics is that Moderates always cave), then my prediction of who got the passes to vote “no” would be wrong:
“Sen. Dean Heller (R-NV) announced Friday that he is opposed to the Obamacare repeal legislation unveiled by Senate GOP leadership this week in its current form and that he will be voting against it if it is brought up for a procedural vote early next week.”
This might pass, but then again everyone hates it. Just about everyone.
@Terrye Cravens:
“but then again everyone hates it.”
True, but not for the same reason. Some, like the Koch Brothers, hate it because it doesn’t hurt the poor enough:
“”This Senate bill needs to get better. It has to get better,” said Tim Phillips, a top lieutenant in the network who recently met with White House officials to outline their proposed changes to the health care system.
The proposed changes to Medicaid, Phillips said, were unacceptable, because they just amount to tinkering around the edges rather than reforming the program. The Senate bill would dramatically scale back federal support of Medicaid and phase out the money that the government has provided to expand eligibility for Medicaid in the states.”