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.
In the House, Aurora GOP Congressman Mike Coffman continued to press for his own approach.
Coffman was one of a handful of Republican representatives that voted against the House bill. Since the House bill passed and efforts have hit a roadblock in the Senate, Coffman has sent a letter to both House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell outlining a way forward by taking a three-part approach to insurance reform.
Coffman said one of the biggest hurdles to getting anything done with reform is the inclusion in both the House and Senate plans of massive changes to Medicaid. While the Affordable Care Act expanded coverage to all able-bodied adults under 65 without children at 138 percent of the federal poverty level, both Republican bills went further in cutting programs that existed before the ACA’s passage.
“One of the problems I have with the bill is it goes into all of the Medicaid program. I don’t think a lot of people realize that the bill that came out of House went way beyond the ACA and into traditional Medicaid,” Coffman said. “Programs for seniors, skilled nursing programs, programs for children, programs for the disabled. All those programs were never part of the ACA and existed prior to the ACA. In my view they should not have been a part of this.”
Coffman’s idea is to not touch those traditional programs. Instead reforms should focus on the expansion under the ACA to abled bodied adults without children and readjust the government’s split with the states from 90/10 to be inlined with other Medicaid programs which for some states like Colorado is a 50/50 split. Along with that adjustment, Coffman said states should move to either a block grant program or a capitated rate plan for the population that gained access to medicaid through the ACA expansion.
“When states don’t have skin in the game on an even cost share they’re less prone to apply for waivers to make it more a more efficient program,” Coffman said.
The second and third part of Coffman’s idea is to split off any discussion of cutting ACA taxes on higher income earners into a separate bill on overall tax reform and to find a bipartisan agreement on how to protect and prop up the health insurance markets.
In the Senate, Republicans publicly sounded optimistic while individual members privately sounded dour.
“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, the No. 2 Senate GOP leader, John Cornyn of Texas, told reporters, “That’s a luxury we don’t have.” Cornyn spokesman Drew Brandewie later said the lawmaker was referring to the unpredictability of the final shape of the bill after amendment votes.
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.
Associated Press writers Erica Werner and Andrew Taylor contributed to this report.