Senate Majority Leader Sen. Mitch McConnell (R-KY) speaks as (from left) Sen. John Barrasso (R-WY), Sen. John Thune (R-SD) and Senate Majority Whip Sen. John Cornyn (R-TX) listen during a news briefing after the weekly Senate Republican Policy Luncheon on July 11. | Alex Wong/Getty Images
Senate Republicans released their revised health care bill Thursday to gut the Affordable Care Act. Unlike their previous bill, which faced stiff GOP resistance, it would maintain some Obamacare taxes on the wealthy, provide new financial support to purchase health insurance and allow health insurers to offer skimpier coverage.
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Senate Republicans’ draft Obamacare repeal bill will tentatively include a controversial amendment from Ted Cruz, a change aimed at building enough GOP support to open debate on the bill next week, according to sources familiar with the matter.
Senate Majority Leader Mitch McConnell will unveil the bill on Thursday morning at a closed-door, GOP members-only meeting. It is also expected to maintain Obamacare’s taxes for the wealthy, include new financial support for low-income people’s insurance, allow people to pay for insurance with pre-tax money, and include billions more to fight opioid addiction, according to a summary obtained by POLITICO.
The amendment from the conservative Texas Republican could be altered or removed later, those sources said. The amendment would allow the sale of cheap, deregulated insurance plans as long as Obamacare-compliant plans are still sold.
It is not yet clear whether the inclusion of Cruz’s proposal will be enough for conservatives. Utah Sen. Mike Lee has previously advocated for the amendment with Cruz, but Cruz has been handling the lion’s share of negotiating with McConnell. Lee is not yet supportive of the latest version because he’s unaware of its content, a spokesman for Lee said.
A conservative aide called it a “good step forward but there’s a lot more work to do.” The bill will also allow consumers to use Health Savings Account money to pay for premiums — another policy conservatives wanted.
Both Cruz and Lee had threatened to vote against starting on the bill if it didn’t have the amendment; more than a half-dozen other Republican senators have stated they don’t support the bill. Any three senators’ opposition would end the GOP’s Obamacare repeal effort on a procedural motion planned for next week, but McConnell is encouraging senators to open debate on the bill and amend it later.
Republicans expect Thursday’s meeting to essentially be an airing of all the GOP’s grievances about the latest draft and help determine whether the party can move forward. McConnell pulled an earlier version of the bill last month amid stiff resistance from conservative and moderate Republicans.
Senators are already angling for more changes. An amendment from GOP Sen. Lindsey Graham would direct much of Obamacare’s federal funding directly to the states that could offer a starting point for Congress if the Senate GOP’s partisan effort fails next week, according to a summary of the bill obtained by POLITICO.
Some Republicans worry that the Cruz proposal could result in split risk pools, one with sick people with pre-existing conditions and the other with healthy young people. Centrists are worried the proposal would undermine protections for people with pre-existing conditions. Cruz and Lee dispute that and will argue it will likely lower premiums and allow people to opt out of Obamacare.
The Cruz amendment would deliver insurance companies subsidies for high-risk Americans with pre-existing conditions under Obamacare’s regulations. If insurance companies offer those plans, they could sell cheap plans that are not subject to those regulations.
Some Republican senators now believe it will be a victory to even open debate on the legislation passed by the House, one senator familiar with the negotiations said.
“I don’t even know that it’s going to get to a vote,” said Sen. John McCain of Arizona.
If that procedural vote is successful, a freewheeling amendment process will begin. At some point, McConnell will introduce a substitute that will represent the Senate’s draft bill. It may be different than what is introduced on Thursday and could be subject to amendment on the Senate floor next week. The bill, in other words, will be a work-in-progress until the final vote.
The Congressional Budget Office is analyzing two versions of the bill, one with the Cruz amendment and one without. The Cruz amendment will be in brackets in the bill released Thursday, indicating it is subject to change.
Senate Majority Whip John Cornyn of Texas declined to say when the CBO score of the Cruz amendment would be released. The analysis for the rest of the draft is expected Monday.
In addition to Cruz and Lee, Sen. Rand Paul (R-Ky.) has cited huge problems with the bill. Paul, who argues the bill keeps too much of Obamacare, has said including the Cruz proposal would not be enough to get his support.
At the other end of the GOP conference, several moderates, including Sens. Susan Collins of Maine and Lisa Murkowski of Alaska are worried that the bill would hurt people with pre-existing conditions and others who got coverage under Obamacare. A number of Republicans are uncomfortable with spending reductions to Medicaid, which covers more than 70 million Americans, including low-income families, people with disabilities and seniors.
Cornyn, who is responsible for gathering the votes for the bill, said there is no other plan that can get 50 votes.
“If you vote “no” on this bill, it essentially is a vote for Obamacare because that’s what we’re going to be left with,” Cornyn said on Fox News Thursday morning. “If Senator Paul can show me 49 other votes for his bill, then I would be all for it. But, unfortunately, the practicality is we have to pass a bill.”
The proposal will also give states new flexibility on their Medicaid funding if a public health emergency — such as a Zika outbreak — takes place. The block grant option would also allow states to add the newly eligible Medicaid population to coverage under the block grant.
The bill also includes $70 billion more than the first draft of the bill’s $112 billion for state-based health care initiatives to drive down premiums. It will include $45 billion for fighting drug addiction and would ease the sale of low-premium “catastrophic” insurance plans.