Tuesday, June 6, 2017

Senate health plan would extend Medicaid expansion past 2020; McConnell sounds more optimistic; aide says Paul's mind is open

The health bill being drafted by Republican senators would extend the Medicaid expansion beyond 2020, the ending date in the health bill the House passed last month, some of them told reporters after meetings on the issue.

"Republicans were reluctant to disclose all the details of the bill but said it would protect those with pre-existing conditions and would keep the Obamacare expansion of Medicaid for several years, even beyond 2020," Susan Ferrechio reports for the Washington Examiner.

Sen. John Barrasso of Wyoming, a physician who chairs the Republican Policy Committee, "said the Senate GOP is looking at a 'glide path' lasting beyond 2020," Bloomberg News reports. “We’re having a good productive discussion about a glide path to help states get to a point where they can get back to [lower funding levels] without an abrupt cutoff,” Barrasso said, according to The Hill.

The Hill reported Wednesday that Senate Majority Leader Mitch McConnell has "proposed a shorter, three-year phase-out that would end [Medicaid expansion] in 2023," and moderate Republican Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia seemed open to the plan.

The expansion of Medicaid covers more Americans than private policies subsidized by the Patient Protection and Affordable Care Act. In Kentucky, the Medicaid expansion covers 470,000 people. Under the House bill, starting in 2020, there would be no more enrollments in the expansion, and those who no longer qualified for it would be unable to regain coverage.

Barrasso, McConnell and Cornyn (Reuters photo by Aaron Bernstein)
Barrasso "said Republicans are discussing a plan, first pitched in a reform bill authored by Sens. Bill Cassidy, R-La., and Susan Collins, R-Maine, that would set up an auto-enrollment system for basic health-care coverage," Ferrechio reports.

Cassidy "said he was feeling increasingly comfortable and 'very encouraged' by Republicans' plans," report Burgess Everett, Jennifer Haberkorn and Adam Cancryn of Politico.

Cassidy dislikes the House bill's authorization for states to waive rules preventing people with pre-existing conditions from being charged more, and the Senate bill would not include that provision, reports Peter Sullivan of The Hill, but "Staffers said the bill would allow states to waive Obamacare rules requiring insurers to cover a range of healthcare services, known as essential health benefits."

Sullivan says some health experts "warn that pre-existing conditions would not be protected even if a state were only allowed to waive the essential health benefits. Sick people could be forced to pay exorbitant prices for a plan that covers their conditions under that scenario."

McConnell, who said two weeks ago that he didn't know how he would get enough votes to pass the bill, sounded more optimistic Tuesday. He told reporters, "We've had plenty of time to discuss this issue. We are getting close to having a proposal to whip and to take to the floor. . . . We'll bring it up in the near future."

McConnell told President Trump that the Senate may vote on the bill before July 4, but set no firm deadline, CNN reports. Reflecting Republicans' impatience with the issue, Sen. Lindsey Graham of South Carolina said, "There had better be."

McConnell's chief deputy, Sen. John Cornyn of Texas, has said the Senate will act on a bill before it leaves for its August recess. He said Tuesday that there have been no agreements about what will be in the bill. Republicans are trying to draft a bill on their own without involving Democrats; that means they can afford to lose only two of their 52 members on a floor vote.

"I think it's more likely to fail than not with the Republican Party only," Graham told Politico, which notes that he "prefers that the law collapse and force a bipartisan solution." But after the Republican lunch Tuesday, Graham sounded more optimistic, calling the options discussed “promising proposals.”

Graham told The Hill that Sen. Rand Paul of Kentucky can't be counted as a vote for the bill and is “irretrievably gone” because he opposes the tax credits that subsidize Obamacare insurance. Paul spokesman Sergio Gor had a tart reply: “While we do have a press assistant opening in the communications department, Senator Graham has not applied, and should not make public statements on behalf of Senator Rand Paul. Senator Paul remains optimistic the bill can be improved in the days ahead and is keeping an open mind.”

Lisa Desjardins of PBS NewsHour reports, "If a bill gets a majority of votes in the Senate, big questions remain about how and if the Senate and House could agree on a final version. That would take several more weeks, or possibly even months. One important date to keep in mind in the health care fight: Sept. 30. Republicans must pass a bill by then in order to use the budget reconciliation process, which would allow the GOP to evade a filibuster attempt.

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