How Mitch McConnell could revive the Senate health care bill
Yahoo News’ continuing coverage of the Republican efforts to repeal and replace Obamacare comes in the latest Health Care Declassified. We’ll combine our own reporting with the best insights from around the Internet to give you the latest on the future of health care in America.
After delaying a vote to repeal Obamacare until after the July 4 recess, Senate Majority Leader Mitch McConnell still faces the challenge of gathering the necessary votes to pass the Better Care Reconciliation Act (BCRA).
Republicans had promised to pass their health care bill this week, but announced Tuesday that the vote would be delayed due to a lack of support from members. The legislation — which was crafted behind closed doors and has had no hearings — was already on precarious ground before receiving its Congressional Budget Office score Monday. That ground became even shakier after the report, which said the legislation would cost millions their health insurance and increase the price of premiums for older and lower income Americans.
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But the delay of the vote doesn’t signal the end of the process in the Senate. It could play out the way the companion House bill did earlier this year: The initial bill doesn’t make it to a vote, the opposition celebrates and a new version emerges with changes to win over enough holdouts on both to pass, earning a Rose Garden celebration. (This is the same legislation President Trump later called “mean.”)
McConnell needs 50 votes to pass the BCRA, with Vice President Pence breaking the tie, as he did in the confirmation of Education Secretary Betsy DeVos. Zero of the 48 Democratic senators are going to cross the aisle, meaning McConnell can afford two defections among his 52 members. How might the Senate majority leader go about wooing those GOP votes? There are a few potential paths, with the Washington Post reporting that McConnell hopes to resubmit a bill to the CBO for scoring by Friday.
Alaska Sen. Lisa Murkowski was one of the earliest critics of the bill. Her vast, thinly populated state has some of the highest health care costs in the nation. Murkowski has said she needed more information on how the bill would affect her constituents before voting.
“What I’m learning is the same problems that we had before, under the House bill, are still there,” said Murkowski in an interview with the Alaska News Dispatch on Tuesday. “That the tax credits don’t take into account much of our high costs.”
Senator Susan Collins of Maine has expressed similar opposition, as her state demographics reflect the older, rural and lower income voters that are projected to suffer the most under the bill.
“It’s difficult for me to see how any tinkering is going to satisfy my fundamental and deep concerns about the impact of the bill,” said Collins to reporters on Tuesday afternoon.
“CBO says 22 million people lose insurance; Medicaid cuts hurt most vulnerable Americans; access to healthcare in rural areas threatened,” wrote Collins on Twitter Monday. “Senate bill doesn’t fix ACA problems for rural Maine. Our hospitals are already struggling. 1 in 5 Mainers are on Medicaid.”
Another no vote is from Sen. Dean Heller of Nevada, the only Republican senator running for reelection in 2018 in a state won by Hillary Clinton. In a joint statement with Nevada Gov. Brian Sandoval — also a Republican — Heller said he was concerned about the effect of the bill on Nevada’s Medicaid recipients.
“You have to protect Medicaid expansion states. That’s what I want. Make sure we’re taken care of here in the state of Nevada,” said Heller.
McConnell could attempt to bring the trio back into the fold by increasing the funding allocated for Medicaid and opioid treatment in the bill. Or McConnell and the White House could try to win over reluctant senators with unrelated favors. Heller is fighting to prevent siting a nuclear waste repository in Nevada’s Yucca Mountain, while Pro Publica reported that an increase in guest-worker visas could be seen as an appeal to Maine and Alaska.
McConnell also has to win over some or all of the four conservatives who say the bill is not doing enough to fully repeal Obamacare. Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah and Ron Johnson of Wisconsin have all come out against the bill, but McConnell must now attempt to appease them without losing further moderate votes.
“Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor,” said the quartet of senators in a joint statement last week. “There are provisions in this draft that represent an improvement to our current health care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs.”
Johnson’s opposition appeared to be softening by midweek, though.
The other problem potentially facing McConnell is that as he addresses specific members he may lose others. After the vote was delayed Tuesday, Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Jerry Moran of Kansas all came out against the bill. With senators returning home over the Independence Day recess, they’re likely to face pushback from constituents over legislation that is at 17 percent approval in an NPR poll released Wednesday morning. It’s even lower — 12 percent — in a USA Today/Suffolk University report. In Tennessee, 62 percent of voters in a new poll want to keep and fix Obamacare.
While Heller is the only GOP senator running for reelection in a state that went blue in 2016, Arizona’s Jeff Flake is defending his seat in a state that Trump won by just 4 points and could become more favorable to Democrats due to the growing population of young, Hispanic voters. Flake, whose father died earlier this week, has not issued any statements about the vote being delayed.
A move that could potentially help sway the caucus is reducing the tax cuts to the wealthiest Americans that the bill would provide. In Lee’s statement Tuesday after the vote was delayed, he specifically cited “ hundreds of billions of dollars in tax cuts for the affluent” as a problem with the bill. It could also potentially appease the White House, as a New York Times report from Tuesday evening implied Trump potentially didn’t understand that aspect of the bill. From the Times report:
A senator who supports the bill left the meeting at the White House with a sense that the president did not have a grasp of some basic elements of the Senate plan — and seemed especially confused when a moderate Republican complained that opponents of the bill would cast it as a massive tax break for the wealthy, according to an aide who received a detailed readout of the exchange.
Mr. Trump said he planned to tackle tax reform later, ignoring the repeal’s tax implications, the staff member added.
The other issue weighing on the Senate is that any major changes senators make would have to be approved by another House vote, which means they would have to appease the block of hard-right Freedom Caucusers as well as the swath of moderates looking to defend their seats in swing districts next fall. McConnell has been in the Senate for three decades and head of the Republican caucus since 2007, but the challenge of repealing Obamacare is shaping up to be the biggest test of his legislative career.
Ron Johnson: ‘We have to do something’
Sen. Ron Johnson, R-Wis., authored a New York Times op-ed Monday titled, “Where the Senate Health Care Bill Fails” — but don’t confuse that with opposition.
“First of all, let me correct the record: I’ve never said I was ‘no’ on this bill,” Johnson said in a Tuesday appearance on MSNBC’s “Morning Joe.”
Johnson’s newfound openness toward the Senate Health Bill comes on the heels of an abysmal Congressional Budget Office evaluation that it would cause 22 million more Americans to be uninsured by 2026, including 15 million more uninsured in the next year alone. Still, Johnson seemed to imply that though he wasn’t enamored with the Senate bill, Republicans should pass it on a party-line vote and then work with Democrats to improve it, instead of the other way around.
“We have to do something,” Johnson said. “Anything we pass is not going to be perfect, so maybe what we’re gonna have to do is, the Democrats passed theirs on a partisan basis, maybe we’ve gotta do this and then hopefully we can take their offer and work together to hopefully fix our healthcare system. I think that’d be best for the American people.” — Gabby Kaufman
How governors could thwart the health care bill
Republican governors will never vote on the GOP health care bill, but some could play a key role in their party’s efforts to repeal and replace Obamacare.
Several GOP governors voiced their reservations with or opposition to the bill, and now have more time to mount pressure on their home state senators to oppose the bill, since a vote won’t take place until Congress convenes after its July 4 recess. Governors hold no authority over their state’s senators, but they could influence their lawmakers and offer welcome political cover.
A major concern for most governors is the bill’s cut to Medicaid funding over the next decade, which would pull billions from their state budgets. About a dozen GOP-led states expanded Medicaid under Obamacare.
Ohio Gov. John Kasich, a Republican who opposes the Senate’s health care bill, appears to have successfully turned up the heat on Rob Portman, Ohio’s GOP senator. Portman publicly opposed the bill Tuesday after Senate Majority Leader Mitch McConnell announced the vote would be delayed.
“The Senate draft before us includes some promising changes to reduce premiums in the individual insurance market, but I continue to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic,” Portman wrote in a statement.
Portman has previously said he had concerns with the bill, but Tuesday marked the first time he announced his opposition. Kasich said Tuesday at a press conference that he had warned Portman about being persuaded to vote in favor by small promises from Republican leaders.
“I told him, ‘If they hand you a few billion dollars on opioids … that’s like spitting in the ocean’ compared to the hundreds of billions the bill would cut from Medicaid,” Kasich said.
Arizona’s Republican Gov. Doug Ducey expressed his concerns with the Senate bill in a letter last week to Sen. John McCain. Though Ducey still supports an Obamacare repeal, he wrote that he needed more time to plug holes in the state’s budget after Medicaid cuts, and he called for more flexibility in the program to allow federal funding to grow relative to inflation.
McCain has said that he plans to vote in favor of the motion to proceed, but has concerns with the bill itself. He also promised to consult other state leaders, including Ducey, about the bill.
“My own governor is extremely worried, because we’re a Medicaid expansion state and we would lose a whole lot of money,” McCain said Tuesday.
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Last Friday, Nevada Republican Gov. Brian Sandoval stood by Sen. Dean Heller, R-Nev., as Heller announced his opposition to the bill. Sandoval, who had previously denounced the bill, expressed concerns that the bill would pull Medicaid coverage from low-income people.
“It’s going to be very difficult to get me to a yes,” Heller said, asking for more protection of Medicaid expansion states.
Heller, up for reelection in 2018 in a state won by Hillary Clinton, is one of the most politically vulnerable senators. — Julia Munslow
Elizabeth Warren backs a single-payer health care system
Amid high profile critiques of her party’s image, Sen. Elizabeth Warren, D-Mass., has proposed a big change to Democratic party platform — single-payer health care. According to Warren, preventing the Better Care Reconciliation Act from being signed into law is only the first step winning over rural, working class voters that largely backed Trump in 2016.
“President Obama tried to move us forward with health care coverage by using a conservative model that came from one of the conservative think tanks that had been advanced by a Republican governor in Massachusetts,” Warren told the Wall Street Journal. “Now it’s time for the next step. And the next step is single payer.”
Should the United States adopt a single-payer health care plan along the lines of the Canadian system, the federal government would fund health care for all residents. California Democrats proposed establishing such a system in the state, but put it on hold last week due to its high cost.
Rep. Tim Ryan, D-Ohio, dismissed the fears of other Democratic leaders who believe advocating for a single-payer system would alienate voters.
“I believe that if we make the argument [that] it’s a good jobs program,” Ryan said on MSNBC. “If you expand health care to everybody, you can’t outsource an occupational therapist, you can’t outsource a physical therapist, you can’t outsource a nurse who does cancer screenings or does preventative work. Those are jobs that could be right here in the United States of America, and we’ll be healthier and prevent a lot of diseases and bend the cost curve on health care.”
Warren, however, has not always supported adopting a single-payer system in the United States. She said that her support for single-payer health care was conditional, depending on if Senate Republicans would be willing to negotiate on amending Obamacare.
Warren plans to run for reelection when her current Senate term ends in 2018. — Taylor Rogers
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