Sunday, June 11, 2017

Democrats slam McConnell's strategy for passing health bill; his office says they will be free to offer amendments

By Al Cross
Kentucky Health News

Senate Majority Leader Mitch McConnell of Kentucky has laid a fast track for Senate Republicans to pass a health bill this month, drawing fire from Democrats who want hearings and a piece of the action.

On Wednesday, June 7, McConnell used a Senate rule to create a legislative vehicle that will allow Republicans' bill, being drafted in private, to be brought to the floor to a vote without going through committees. He has said Democrats won't be involved in drafting the bill because "They're not interested in doing what we're interested in doing."

In a Finance Committee meeting, Sen. Claire McCaskill, D-Mo., asked Chairman Orrin Hatch, R-Utah, if the committee would hear the bill. Hatch replied, "Well, I don't know if there's going to be another hearing, but we've invited you to participate and give your ideas." McCaskill responded, "No, that's not true, Mr. Chairman. . . . We have no idea what's being proposed. There's a group of guys in a backroom somewhere that are making these decisions. There were no hearings in the House."

McConnell's opposite number, Minority Leader Chuck Schumer of New York, speaking on CBS's "Face the Nation," said, “To have this issue, which affects a sixth of our economy, tens of millions of people . . . would lose coverage, lose [coverage of] pre-existing conditions, hurting the elderly, hurting women, to do this in private without hearings, without amendments, it would be one of the most outrageous examples of legislative malpractice in decades. I am appealing to Leader McConnell, once you have your bill, once you have your bill, put it forward in public like we Democrats did.”

McConnell's office offered this reply: "The entire Senate Republican conference continues to work on legislation to rescue the millions of Americans trapped by Obamacare. The reality is doing nothing is not an option, and that’s why Republicans have been holding meetings at least three times a week in an effort to provide relief for the American people. Democrats had years to offer solutions to the problem, but refused. Since this legislation will be open to a full amendment process, Democrats will have the opportunity to share their yet-unknown ideas to help American people."

The fate of the bill is a highly speculated topic in Washington, and there is considerable skepticism. "It’s always a mistake to underestimate McConnell’s ability to make things happen in the chamber he’s occupied for decades, but the task he’s set for himself over the next few weeks looks like a heavy lift, even for him," Rob Garver wrote in an analysis for The Fiscal Times. But on "Face the Nation," Susan Page of USA Today said, "I'm not betting against Mitch McConnell."

The day before, The Washington Post published an op-ed by Andy Slavitt, who ran the Centers for Medicare and Medicaid Services in the Obama administration, saying that McConnell is using "sabotage, speed and secrecy" to pass a health bill that most Americans don't want.

Sabotage is being used to build the Republican argument that the Patient Protection and Affordable Care Act has failed, which the facts don't support, Slavitt writes. "Medicaid — which accounts for the bulk of the ACA coverage expansion — is successful, popular and bipartisan," he says. "The ACA’s individual insurance exchanges got off to an uneasy start, but after five years, insurer filings and independent reports all point to profitable insurers and stable or stabilizing markets — at least until President Trump intervened to rattle insurers."

Trump suggested that the government would stop paying cost-sharing subsidies to insurers, which in some states has prompted them to file two sets of propose rates for 2018: one if the subsidies continue, the other if they are eliminated. In North CarolinaBlue Cross Blue Shield proposed rate increases averaging 8.8 percent under continuation, 23 percent under elimination, Richard Craver reports for the Winston-Salem Journal.

Speed is needed to "minimize pressure on vulnerable senators," Slavitt writes, so McConnell is using the fast-track procedure that will ready the bill for a vote after scoring by the Congressional Budget Office. "Knowing the coverage loss will be significant, McConnell plans to vote within only days, or possibly even hours, of the release of the CBO score," Slavitt writes. "Moving fast leaves opponents, and the public, with no time to catch up to the details."

Slavitt says McConnell needs secrecy because the Senate bill will look a lot like the House bill, titled the American Health Care Act, which only 8 percent of Americans in a May poll said they wanted. "The ACA’s expansion of Medicaid would end," though on a slower timetable. "The caps on Medicaid spending imposed by the House bill would remain. With state approval, insurers would still be able to offer Swiss-cheese policies that drop benefits people with pre-existing conditions need most."

Secrecy is also needed "for backroom deals" with some Republican senators, Slavitt writes. "Given the opioid crisis in her state, one would think the AHCA’s severe Medicaid cuts would mean Shelley Moore Capito (W.Va.) would never support it; the majority of opioid treatments in her state are provided by Medicaid. Similarly, one would think there is no price that would cause Lisa Murkowski (Alaska) to sign on to a deal whose consequences for her state would be worse than any other state," at least for private insurance. "But McConnell is counting on being able to buy their votes relatively cheaply: possibly with a small 'opioid fund' and an extra few years before the Medicaid expansion ends in certain states."

Slavitt argues that McConnell should move in the direction of Republican Sens. Bill Cassidy (La.), and Susan Collins (Maine), who have "talked about finding solutions that would lead to more people covered, not fewer. That’s an approach that could bring many Democrats to the table." Since the 100-member Senate has only 52 Republicans, a bipartisan approach could "change the course we’re on and put health-care reform on a path to long-term political stability," Slavitt writes. "And McConnell himself might not even mind. Something short of 50 votes will preserve the Senate’s role as our deliberative body with the good judgment not to bow to the political winds, particularly when the country needs its checks and balances to work like never before."

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