Monday, July 17, 2017

After fellow Republicans kill his bill, McConnell adopts an idea he had dismissed: repeal Obamacare now, replace it later

Sen. Mitch McConnell (Getty Images)
By Al Cross
Kentucky Health News

With his health-insurance bill killed by fellow Republicans late Monday, Senate Majority Leader Mitch McConnell quickly adopted a version of idea he had dismissed: repealing the Patient Protection and Affordable Care Act, but with a two-year delay.

But that strategy quickly fell apart, as Republican senators from West Virginia, Maine and Alaska said they couldn't support it. That could make operative the warning McConnell gave Republicans last month, that if they couldn't pass a comprehensive bill on their own, they would have to join with Democrats to stabilize the market for private health insurance.

But John Bresnahan and Burgess Everett of Politico reported that McConnell "is wary of following Sen. Lamar Alexander (R-Tenn.) and other Republicans into bipartisan negotiations to save the insurance markets, according to GOP sources."

After Republican Sens. Jerry Moran of Kansas and Mike Lee of Utah said in a joint announcement Monday night that they couldn't support McConnell's revised bill, he said he would use the House passed May 4 as a vehicle for a repeal-now, replace-later strategy like that advocated by his Kentucky seatmate, Republican Rand Paul. President Trump had also suggested that strategy, and did it again Monday night.

McConnell had said the strategy wouldn't work, but around 10:45 p.m. Monday, he issued this statement: “Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful. In the coming days, the Senate will vote to take up the House bill with the first amendment in order being what a majority of the Senate has already supported in 2015 and that was vetoed by then-President Obama: a repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care.” He declined to be more specific about “the coming days.”

Sens. Jerry Moran, Mike Lee (N.Y. Times)
Around 9 p.m., Lee and Moran had joined Paul and moderate Republican Susan Collins of Maine in publicly opposing McConnell's revised bill. That left the majority leader two votes short of the 50 he needed from Republicans to advance the bill.

Asked June 30 about the idea of repealing now and replacing later, McConnell said he would "stick to" his strategy of passing a comprehensive repeal bill only with Republican votes.

McConnell said in early June that he wasn't working with any of the 48 Democrats because "They're not interested in doing anything we're interested in doing" on health care, but in late June he warned Republicans that if they couldn't pass a comprehensive overhaul on their own, they would have to join with Democrats to stabilize the market for private health insurance, including taxpayer-subsidized plans.

"My suspicion is in any negotiation with Democrats will include none of the reforms that we would like to make on the market side and the Medicaid side," McConnell said then.

Before McConnell's late-night announcement, Senate Democratic Leader Chuck Schumer of New York called for a bipartisan effort. “This second failure of Trumpcare is proof positive that the core of this bill is unworkable,” Schumer said. “Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long-term stability to the markets and improves our health-care system.”

McConnell had promised a vote on his bill this week, but had to back off when Sen. John McCain of Arizona was sidelined by surgery. Paul said Sunday that the delay would give conservatives time to realize that the bill wasn't what they want.

McConnell had hoped to get Lee's vote by allowing insurance companies to sell the sort of low-cost, low-coverage plans that the 2010 law prohibited. (Insurance companies said the language would split the insurance market between the health and not so healthy, driving up costs for the latter.)

Sweeteners that McConnell added to the bill to get moderates, such as more money to treat opioid addiction and a one-year delay in the phase-out of Medicaid expansion, forced him to keep Obamacare's taxes in the bill, and Lee objected to that.

Also, The Associated Press reports, Lee said the bill didn't "go far enough in lowering premiums for middle class families" or "create enough free space from the most costly Obamacare regulations." Moran said the bill "fails to repeal the Affordable Care Act or address health care's rising costs."

"Moran faced pressure at home about how the bill would affect Kansas, including its rural hospitals," The New York Times noted, "The Kansas Hospital Association said last week that the latest version “comes up short, particularly for our most vulnerable patients.”

The Kentucky Hospital Association likewise opposed McConnell's plan to phase out federal funding for expansion of Medicaid, which has boosted many Kentucky hospitals. It said that if the expansion was phased out, Congress should restore the 2010 law's cuts in special reimbursements to rural hospitals for care of Medicare patients.

"The collapse of the Senate Republican health bill — and the failing struggle to find yet another alternative —highlighted a harsh reality for Senate Republicans: While Republican senators freely assailed the health law while Mr. Obama occupied the White House, they have so far not been able to come up with a workable plan to unwind it that would keep both moderate Republicans and conservatives on board," writes the Times' Thomas Kaplan.

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