Sen. Mitch McConnell. R-Ky C-SPAN
Sen. Mitch McConnell. R-Ky C-SPAN

Washington — Sen. Mitch McConnell rolled out a new health care bill that is broadly similar to the one that foundered in the Senate last month, but contains a few new provisions aimed at winning over recalcitrant Republican senators.

Like the previous bill, the latest effort to repeal and replace Obamacare would cut federal Medicaid dollars to states and trim the Affordable Care Act’s subsidies that help low- and middle-income Americans buy health insurance for themselves and their families.

Like the previous bill, the new version of the Better Care Reconciliation Act (BCRA) would eliminate the requirement that most people have health insurance and all but businesses with fewer than 50 full-time employees cover their workers.

And it would roll back many taxes imposed to fund the ACA — but not all of them. The new BCRA would keep a Medicare tax surcharge on individuals earning $200,000 or more — and families earning $250,000 or more — and keep a cap on the deduction insurers can take on salaries paid to their executives at $500,000.

But it included new provisions aimed at wooing Senate GOP conservatives like Ted Cruz, R-Texas, and Mike Lee, R-Utah, including one that would allow insurers, under certain conditions, to offer health plans that did not comply with requirements of the Affordable Care Act.

If an insurer offered an ACA-compliant plan in a state, it would be allowed to offer less comprehensive, cheaper policies, too. State residents would be allowed to use their subsidies to purchase either ACA-compliant or pared-down plans.

Since the more generous ACA-compliant plans would attract older and sicker customers who would generate higher medical costs, the new bill contains a fund that would help cover the cost of these high-risk patients.

Cruz called the move to allow stripped-down plans “very encouraging.”

“I think we’re making serious progress towards coming together and unifying our conference and getting a bill that can command the support of at least 50 senators and pass into law,”  he said in a radio interview.

The new bill also would allow people for the first time to pay for insurance premiums — as well as other health-related expenses — out of their tax-exempt health savings accounts.

McConnell plans to schedule a vote on the bill next week, but its unclear it will win support from moderate Senate Republicans, who are concerned about its Medicaid cuts and defunding of Planned Parenthood by barring any Medicaid payments to the organization’s clinics.

The changes to the bill did nothing to attract Democratic support for the Better Care Reconciliation Act, and if anything, hardened already rock-solid Democratic opposition.

Sens. Chris Murphy and Richard Blumenthal File Photo

“Trumpcare 4.0 is a disaster for Connecticut, just like every previous version. And in some ways, it actually might be worse,” said Connecticut Sen. Chris Murphy. “Millions will lose their health insurance. Sick and older people will see costs skyrocket. Protections for people with pre-existing conditions will be gutted with insurance companies put back in charge”

Like many Democrats, Murphy urged Republicans to “drop this bill” and negotiate with Democrats to fix the shortcomings of the ACA.

Sen. Richard Blumenthal, D-Conn., called the bill “an abomination to anyone who cares about the future of healthcare in the United States of America.”

Medicaid cuts and a competing GOP plan

The revised bill would provide an additional $70 billion to states to help them reduce premiums, lower out-of-pocket expenses and take other steps to make health care affordable. That money would be added to the $112 billion already in the state “stabilization” fund.

But the bill’s deep cuts to Medicaid are vigorously opposed by Democratic governors, and several Republican governors, who, like Gov. Dannel P. Malloy, made use of an ACA provision that provided generous federal payments to help expand Medicaid to include single adults and those earning up to 133 percent of the federal poverty level.

The Better Care Reconciliation Act phases out that Medicaid expansion money. It also would cap federal payments for the rest of the state’s Medicaid population at a set amount per person. Currently Connecticut shares the cost of covering those patients with the federal government on a 50-50 basis, not matter how much in medical expenses the state incurs.

Medical costs are higher in Connecticut than in most other states, so a cap based on the average Medicaid expenditures probably would result in a funding shortfall that would force the state to make tough choices, including boosting its own spending or cutting eligibility or payments to hospitals and doctors.

Malloy has estimated that the Senate bill eventually would cost Connecticut nearly $3 billion in lost Medicaid payments every year starting in 2026.

“The Senate Republicans continue to put American lives on the line for no other reason than following through on an ill-advised campaign pledge,” Malloy said. “For many of our most vulnerable populations, including the elderly and the sick, this bill is as cruel as it is dangerous.”

Malloy also said “it is inconceivable that Senate Republicans would move even further toward jeopardizing the cost and quality of coverage for people with pre-existing conditions simply to appease some of their most radical members.”

The new bill contains a new Medicaid option for governors. Instead of receiving federal payments based on a per-capita formula, they could receive the federal share of the program in a block grant that would be adjusted in the case of a medical emergency. Governors also would be able to include those who receive coverage under the Medicaid expansion in their block grant applications.

The Congressional Budget Office, which said the previous bill would eventually result in a loss of insurance coverage for an additional 22 million Americans, will release an analysis of the new bill in the next few days.

But the legislation has been challenged by two Republican senators, Bill Cassidy of Louisiana and Lindsey Graham of South Carolina, who introduced a competing plan Thursday.

It would block grant about $500 billion of federal spending to the states over 10 years to either repeal, repair or keep Affordable Care Act program.

Cassidy and Graham say their plan, which they hope to bring up as an amendment to the BRCA, would bridge the divide between Republicans and could even attract some Democratic votes.

Ana has written about politics and policy in Washington, D.C.. for Gannett, Thompson Reuters and UPI. She was a special correspondent for the Miami Herald, and a regular contributor to The New York TImes, Advertising Age and several other publications. She has also worked in broadcast journalism, for CNN and several local NPR stations. She is a graduate of the University of Maryland School of Journalism.

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