Senate Republican leaders on Thursday unveiled a rewritten proposal to repeal and replace Obamacare which aims to help hold down insurance costs for consumers and give insurers the freedom to sell new, low-cost, stripped-down policies.
Changes, which include an expansion on the use of health savings accounts, were made in order to bridge the gap between the Senate’s most conservative Republicans and moderate Republicans who have concerns about some people being left without insurance. However, at least two Republican senators; Susan Collins of Maine, a moderate, and Rand Paul of Kentucky, a conservative, said they were not impressed.
A key procedural vote could take place as early as next week, but after the bill was made public, several moderate lawmakers approached Senate Majority Leader Mitch McConnell (R-Ky.) in his office to tell him that they still have concerns and requested specific changes in the bill, including tens of billions more in funding.
Like its predecessor, the revised bill would roll back the expansion of Medicaid under the Affordable Care Act and would still convert Medicaid from an open-ended entitlement to a system of fixed payments to states. However, in the event of a public health emergency, the potential surge in state Medicaid spending would not be counted toward the spending limits, known as per capita caps.
The revised bill would provide roughly $70 billion in additional funds that states could use to help reduce premiums and hold down out-of-pocket medical costs, but moderate Republicans want assurances from McConnell on how that money will help lower-income people purchase insurance.
Republican Sens. Dean Heller (Nev.), Lisa Murkowski (Alaska), Rob Portman (Ohio), Shelley Moore Capito (W.Va.) and John Hoeven (N.D.) all attended the meeting in McConnell’s office.
With every Democrat in the Senate prepared to vote no, McConnell needs at least 50 votes; and Vice President Pence would then cast the tie-breaking vote.
Sen. Ted Cruz (R-Texas) is reportedly ready to vote for the bill after McConnell placated him with language giving insurance companies more flexibility in what kind of plans they are permitted to sell. However, this led to moderates expressing concerns that premiums will subsequently rise on sick people and those with pre-existing conditions.
After the meeting, Sen. Hoeven said he is uncertain whether the bill has enough money in a long-term “innovation” fund designed to help states ensure people can buy insurance. The amount has already been raised to $132 million.
“We need to see what amount we’d have now with the increase in the long-term fund and then we can determine from there what we need,” he said.
Asked if the $70 billion in additional funding was enough to ease his concerns, Hoeven said, “This is why we need to see the numbers. I’m reserving judgment at this point. I want to see the [Congressional Budget Office] score.”
The CBO scores will be issued on Monday.
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