Saturday, July 15, 2017

McConnell tries to sell 'Medicaid Republicans' from Ohio, W.Va., 3 other states on new health-insurance bill; Paul remains opposed

Kentucky Health News

“By most measures,” writes Paul Kane of The Washington Post, Senate Majority Leader Mitch McConnell and his Republican allies “face a nearly impossible task of finding enough votes to pass their long-promised repeal of the Affordable Care Act,” because Sen. Rand Paul and the Senate's most moderate Republican say they oppose the bill, and that leaves McConnell with no votes to spare.

“Yet by one measure,” Kane adds, “Republicans have never been closer to actually repealing large chunks of what they dismiss as ‘Obamacare.’ Within two short weeks, the party will probably either be reveling in its unexpected victory or mired in deep infighting over the party’s failure to live up to a pledge it has made over the past seven years.”

That time frame may be extended a week. On Saturday night, McConnell postponed action on the bill by a week because Sen. John McCain is recuperating in Arizona from surgery to remove a blood clot above an eye.

McConnell is trying to pass the bill through "budget reconciliation," one exception to the Senate's 60-vote filibuster policy, because Republicans hold only 52 of the 100 Senate seats. But with Paul and Maine Sen. Susan Collins publicly opposed, McConnell needs to get every other Republican and a tie-breaking vote from Vice President Mike Pence.

"Some Republicans remain optimistic" that McConnell "can pull off the negotiating tricks necessary, but he still faces an uphill fight in winning the votes to pass the Better Care Reconciliation Act by his tentative deadline of Friday," July 21. Key House members told Kane that if the Senate passes the bill, their chamber would pass it and send it to President Trump.

Senate Majority Leader Mitch McConnell answered reporters'
questions in Bowling Green. (AP photo by Austin Anthony)
Trump put more pressure on McConnell July 12, saying "Mitch has to pull it off. He's working very hard. He's got to pull it off." If not, "I will be very angry about it."

Late Friday, July 14, McConnell met with five Republican senators who haven't agreed to his revised bill because it still phases out federal funding for the expansion of Medicaid and sets long-term Medicaid spending limits that would keep the program from keeping pace with health-care costs and force states to make cuts. Kentucky is one of the most Medicaid-dependent states.

"Dean Heller of Nevada, Lisa Murkowski of Alaska, Rob Portman of Ohio, Shelley Moore Capito of West Virginia and John Hoeven of North Dakota" asked McConnell "to rework proposed changes to Medicaid in exchange for their 'yes' votes," Fox News reported.

The Post reported earlier that McConnell told Capito and Portman that future Congresses are likely to block the cuts. That report concerned Wisconsin Sen. Ron Johnson, who said it put "in jeopardy" his vote for the motion to proceed with the bill.

The proposed Medicaid changes also concern hospitals, but "One hospital industry lobbyist said there has been no attempt by Republican leadership to have a serious discussion with industry lobbyists or leaders about how to change the bill to win their support," reports Yasmeen Abutaleb of the Reuters wire service. Likewise, when the six major physicians' lobbies made their first joint plea, against the bill, they didn't get to meet with McConnell, the Post reported.

An unnamed senator told Fox that McConnell was unlikely to relax the Medicaid spending formula but might give the holdout senators assurances about how $70 billion in insurance subsidies that he added to the bill would help "lower-income Americans buy insurance." Under the bill, people earning more than about $42,000 a year "would face sharp premium increases," The New York Times' Margot Sanger-Katz reports.

The private insurance market is a greater concern than ever because McConnell, to get support from Texas Sen. Ted Cruz and perhaps some of his ardently conservative allies, added to the bill a provision that would allow insurance companies sell low-cost, low-coverage policies, something Obamacare outlawed in order to help the companies cover people with pre-existing conditions and deal with other facets of the law.

The two largest groups in the health-insurance industry called the Cruz amendment "simply unworkable," saying it would jack up costs for sick or vulnerable people and limit options for those who buy individual plans.

The CEOs of America's Health Insurance Plans and the Blue Cross Blue Shield Association told McConnell and Minority Leader Chuck Schumer of New York) Friday that the amendment "would undermine protections for those with pre-existing medical conditions, increase premiums and lead to widespread terminations of coverage for people currently enrolled in the individual market," and would create "two systems of insurance for healthy and sick people. As healthy people move to the less-regulated plans, those with significant medical needs will have no choice but to stay in the comprehensive plans, and premiums will skyrocket."

Kathryn Watson of CBS News notes, "The letter could be dismissed by Republicans, however, as the current head of AHIP is Marilyn Tavenner, who helped implement Obamacare as the head of the Center for Medicare and Medicaid Services."

Other major changes McConnell made in the bill would allow pre-tax income to be used to pay premiums through health savings accounts, used largely by those with above-average incomes, and add $45 billion for opioid-addiction treatment, a major concern in Kentucky, Ohio and West Virginia.

To pay for that and the insurance subsidies, McConnell dropped from the bill a planned repeal of three taxes that help finance Obamacare: a 3.8 percent levy on net investment income, a 0.9 percent Medicare payroll tax on people making $200,000 a year or couples earning $250,000, and a tax on highly paid health-insurance executives. "Lawmakers such as Sen. Bob Corker (R-Tenn.) said repealing those taxes would give too much relief to the wealthy at the expense of the poor," the Post reported.

McConnell could have room to add more money to the bill after Monday, July 17, when the Congressional Budget Office will estimate the measure's effect on revenue and spending.

Sen. Rand Paul
Meanwhile, Paul said McConnell's latest bill has nothing "remotely resembling repeal." Last week, he said he and his Kentucky Republican seatmate have had no negotiations about it.

Gov. Matt Bevin, speaking at the National Governors Association's summer meeting, "sharply criticized his party’s decision not to eliminate a pair of taxes on high earners," Jonathan Martin of the Times reports. “They’re going to lose as many votes as they’re getting,” Bevin said, adding that there had been an “understanding that those two taxes were going to be gone.”

McConnell has said that if Republicans can't pass a bill with their own votes, they will have to work with Democrats to stabilize the private insurance market.

"Across the country, Americans are losing choice and access under Obamacare," McConnell said in a speech on the Senate floor as he rolled out his revised bill. "Things are not likely to turn around unless we act."

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