Senate Republicans Unveil New Health Bill, but Divisions Remain

69 views


“I want to make sure that with regard to those people who are currently getting coverage under Medicaid expansion, that we have some options for them,” Mr. Portman said.

Two other Republican senators, Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, went on television to promote their own alternative plan, just minutes before Senate leaders offered their latest.

With 52 Republicans in the Senate, and two firm “no” votes already, a single new defection would doom the bill and jeopardize the Republicans’ seven-year quest to dismantle the health law that is a pillar of President Barack Obama’s legacy.

Democrats probed for weaknesses in the Republican ranks.

“The Republican Trumpcare bill still slashes Medicaid,” Senator Chuck Schumer of New York, the Democratic leader, said. “The cuts are every bit as draconian as they were in the previous version — a devastating blow to rural hospitals, to Americans in nursing homes, to those struggling with opioid addiction and so many more.”

Photo

Senator Susan Collins, Republican of Maine, said Thursday that she remained opposed to the new health care bill.

Credit
Eric Thayer for The New York Times

If enacted, the bill would be a sharp departure from more than a half-century of efforts by Congress and presidents of both parties to expand health insurance coverage, through a patchwork of federal programs.

Repealing the Affordable Care Act is a high priority for President Trump and House Republicans, who passed their own version of a repeal bill on May 4. Republicans say they are trying to stabilize insurance markets and rescue consumers who face sky-high premiums and deductibles on the Affordable Care Act’s exchanges.

But passing a bill is proving to be a huge challenge in the Senate, just as in the House, which struggled with its repeal measure. Over all, the new version of the Senate bill made broad concessions to conservative Republicans who had said that the initial draft left too much of the Affordable Care Act in place. Senator Mitch McConnell of Kentucky, the majority leader, then backfilled the bill with money intended to placate moderates.

The resulting mix left neither side completely satisfied.

The revised bill, like the previous version, would roll back the expansion of Medicaid under the Affordable Care Act, and it would still convert Medicaid from an open-ended entitlement to a system of fixed payments to states. However, in the event of a public health emergency, the resulting surge in state Medicaid spending would not be counted toward the spending limits, known as per capita caps.

The revised bill would provide roughly $70 billion in additional funds that states could use to help reduce premiums and hold down out-of-pocket medical costs.

Interactive Graphic

Where Every Senator Stands on the Revised Health Care Bill

A real-time count of every senator’s position.



OPEN Interactive Graphic


In a departure from current law, the bill would allow insurers, under certain conditions, to offer health plans that did not comply with standards in the Affordable Care Act. Under that law, insurers sell regulated health plans through a public insurance exchange in each state and must provide “essential health benefits,” such as maternity care, emergency services and mental health coverage.

Under the Senate bill, if an insurer offered several plans on state exchanges that were subject to the Affordable Care Act mandates, it could also offer coverage outside the exchanges that would be exempt from most of those regulations.

Insurance plans could escape from some of the most important consumer protections in the Affordable Care Act, such as prohibitions on discrimination based on a person’s health status, medical condition, claims experience, medical history or disability.

This part of Mr. McConnell’s bill, incorporating ideas from Senator Ted Cruz, Republican of Texas, was tacked onto the end of the bill and is enclosed in brackets. Aides to Senate Republicans said the brackets meant that the language was not final and could be revised in light of comments from other senators.

Mr. Cruz said the inclusion of this provision was “very significant progress,” and he called the revised bill a “substantial improvement.” But insurers and consumer advocates worried that the new provision would send healthy consumers to low-cost, basic health plans, leaving sick and older consumers to purchase more comprehensive health policies at much higher prices.

Photo

Senator Ted Cruz, Republican of Texas, said of passing a new health care bill, “I think failing to get this done would be really catastrophic.”

Credit
Tom Brenner/The New York Times

To compensate, Republican leaders allocated tens of billions of dollars in their bill to try to offset rising premiums. Consumers could not use federal tax credits to help pay premiums for coverage that did not meet federal insurance standards.

Senator Chris Coons, Democrat of Delaware, said the section of the bill based on Mr. Cruz’s proposal “would allow insurers to offer junk health insurance plans.”

“To me, that is like allowing car companies to sell cars without airbags, bumpers, or emergency brakes,” Mr. Coons said. “It might make the cars cheaper, but the cars are too dangerous to drive.”

In another change, the bill would allow people to use tax-favored health savings accounts to pay insurance premiums. Republicans said this policy change would increase health care coverage.

The bill also provides $45 billion to help combat the opioid abuse crisis — a provision that was particularly important to two Republican senators who opposed the previous version of the bill, Mr. Portman and Ms. Capito.

Graphic

How Senate Republicans Plan to Dismantle Obamacare

A comparison of the Senate health care with the Affordable Care Act.



OPEN Graphic


In a notable change, the revised bill would keep two taxes imposed by the Affordable Care Act on people with high incomes: a 3.8 percent tax on investment income and a 0.9 percent payroll tax. The taxes apply to individuals with income over $200,000 and couples with income over $250,000. Those taxes would have been repealed under the previous Senate bill, reducing federal revenue by about $231 billion over a decade, according to the congressional Joint Committee on Taxation.

The updated bill would also retain limits on the tax deductions that insurers can take for compensation paid to top executives. The previous Senate bill would have removed those limits, imposed by the Affordable Care Act.

To succeed, Mr. McConnell must win over all the holdouts in his caucus, a daunting and delicate task given the litany of complaints he has faced and the sharp policy differences among Senate Republicans.

“This is our chance to bring about changes we’ve been talking about since Obamacare was forced on the American people,” Mr. McConnell said. “It’s our time to finally build a bridge away from Obamacare’s failures and deliver relief to those who need it.”

But Ms. Collins and some Democrats, such as Senator Mark Warner of Virginia, say it is time to recognize the flaws in the Affordable Care Act and try to find bipartisan solutions, without such far-reaching legislation.

Republicans expect that an analysis of the revised bill will be released by the nonpartisan Congressional Budget Office early next week. The previous version would have increased the number of people without health insurance by 22 million in 2026 compared with current law, the budget office found.

Mr. McConnell said he would then move to take up the bill for debate, amendments and a final vote — if he can get 50 willing senators.

Continue reading the main story

Source link

Senate Republicans Unveil New Health Bill, but Divisions Remain

Tags: #Healthcare #Healthcare Info #Healthcare News #Healthcare Recipe #Healthcare Trick #Healthy Lifestyle