WASHINGTON

Senate health care bill already under fire from GOP members

Erin Kelly, and Eliza Collins
USA TODAY

WASHINGTON — After weeks of closed-door meetings, Senate Republican leaders Thursday unveiled a health care bill that would largely scrap Obamacare by making deep cuts in Medicaid, ending the mandate that everyone buy insurance, repealing taxes on wealthy Americans and insurance companies, and stripping funding from Planned Parenthood for a year.

Senate Majority Leader Mitch McConnell, followed by Majority Whip John Cornyn, leaves a Republican meeting on health care on June 22, 2017, on Capitol Hill.

However, four conservative Republican senators — Rand Paul of Kentucky, Ted Cruz of Texas, Ron Johnson of Wisconsin and Mike Lee of Utah— said they "are not ready to vote for this bill" because it does not go far enough in repealing Obamacare. Separately, moderate GOP Sen. Dean Heller of Nevada said he has "serious concerns" about the bill's impact on Medicaid patients.

"Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor," Paul, Cruz, Johnson and Lee said in a joint statement. "There are provisions in this draft that represent an improvement to our current health care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs."

Senate Majority Leader Mitch McConnell, R-Ky., expects the 142-page bill — which he called a "discussion draft" — to come to the floor for a vote as early as next week, after the non-partisan Congressional Budget Office has estimated its cost and impact. Democrats are united against it, meaning that McConnell can afford to lose only two GOP votes.

Majority Whip John Cornyn, R-Texas, said senators will be able to offer an unlimited number of amendments on the Senate floor. The CBO said it expects to have its analysis of the bill done early next week.

"Now that it is known that there are not 50 votes for this, I hope that those who are writing the bill — have written the bill — will negotiate with us,” Paul said.

GOP leaders said the bill represents Republicans' best chance to deliver on their campaign promise to repeal and replace the Affordable Care Act — President Obama's signature health care law. Republican lawmakers and President Trump have railed against the law, charging that it has raised insurance premiums and driven insurers out of the marketplace. Democrats say Republican lawmakers and President Trump have undermined Obamacare by creating uncertainty among insurers and threatening to withhold the federal payments they receive for offering lower-cost insurance to struggling Americans.

"We agree on the need to free Americans from Obamacare’s mandates, and policies contained in the discussion draft will repeal the individual mandate, so Americans are no longer forced to buy insurance they don’t need or can’t afford," McConnell said on the Senate floor after briefing his GOP colleagues about the bill.

McConnell said the bill will "eliminate costly Obamacare taxes that are passed on to consumers, so we can put downward pressure on premiums; expand tax-free health savings accounts and deploy targeted tax credits, so we can help defray out-of-pocket costs; and shift power from Washington to the states, so they have more flexibility to provide more Americans with the kind of affordable insurance options they actually want."

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Trump, speaking at the White House on Thursday, indicated the Senate bill is not a final product. "Obamacare is dead, and we're putting a plan out today that is going to be negotiated."

Senate Minority Leader Charles Schumer, D-N.Y., said the bill "would end Medicaid as we know it."

"This is a bill designed to strip away health care benefits and protections from Americans who need it most in order to give a tax break to the folks who need it least," Schumer said. "This is a bill that would end Medicaid as we know it, rolling back Medicaid expansion, cutting federal support for the program even more than the House bill."

"Simply put, this bill will result in higher costs, less care, and millions of Americans will lose their health insurance, particularly through Medicaid," he said. "It's every bit as bad as the House bill, in some ways even worse."

The House passed a different version of the bill on May 4, but senators immediately rejected it and said they would start from scratch on their own proposal. Like the House bill, the Senate measure allows insurers to raise premiums on older policy-holders and would make make it harder than current law for people to qualify for income-based subsidies to help pay for coverage.

The Senate plan does not include a House provision that would let states get waivers to allow insurance companies to raise premiums on some Americans with pre-existing medical conditions. Both the House and Senate bill would phase out the expansion of Medicaid eligibility, but the Senate bill does it more slowly.

Heller, a vulnerable Republican who is up for re-election next year in his swing state, said Thursday he has "serious concerns" about the bill's impact on Medicaid patients in Nevada.

"Throughout the health care debate, I have made clear that I want to make sure the rug is not pulled out from ... the more than 200,000 Nevadans who received insurance for the first time under Medicaid expansion," Heller said in a statement. "At first glance, I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid. I will read it, share it with Gov. Sandoval, and continue to listen to Nevadans to determine the bill’s impact on our state. ... As I have consistently stated, if the bill is good for Nevada, I’ll vote for it and if it’s not — I won’t."

The bill includes $2 billion for opioid addiction treatment in 2018. Sen. Shelley Moore Capito, R-W.Va., a key moderate, said that was not nearly enough.

"They did say there was some opioid funding, but it’s not nearly the amount we had asked for," Capito said. "I need to look at it and read it to make that final determination (on whether it's a deal breaker). I’m not going to do that right now."

Sen. Lamar Alexander, R-Tenn., chairman of the Health, Education, Labor and Pensions Committee, said the $2 billion would be the largest amount of money Congress has allocated in one year to fight opioid addiction. He said he expects some senators to push to add more money when the bill comes to the Senate floor.

Democrats said the opioid funding will not make up for the cuts to Medicaid, which provides health care for many addicts.

Sen. Bill Cassidy, R-La., said he remained undecided about the bill after the GOP briefing Thursday. He said he wanted to read the bill carefully before making up his mind.

"I will study the bill to determine whether it fulfills President Trump's campaign promises to lower premiums, maintain coverage and protect those with pre-existing conditions without mandates," he said.

Sen. Bill Cassidy leaves a closed meeting with Senate Republicans on Capitol Hill on June 22, 2017.

Trump was already lobbying senators to support the bill even before the Senate proposal was unveiled. Paul got a call from the president, his office confirmed Thursday. Paul told Trump he could not commit to how he would vote and joked that he and Trump may have to golf together again to discuss the legislation, according to Paul spokesman Sergio Gor.

The Senate bill would cut Medicaid funds from organizations that provide abortions for one year. It does not mention Planned Parenthood by name, but the legislation is clearly targeting the organization, which Republican leaders have promised to defund.

Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, have both expressed concerns about any legislation that defunds Planned Parenthood. Murkowski and Collins said Thursday they were still reviewing the bill's provisions.

"It makes no sense to single out Planned Parenthood from all the Medicaid providers and say that it can’t be a Medicaid provider," Collins said. "There’s already a ban against using federal funds for abortion so there’s absolutely no need for that."

The legislation would also bar low-income women from using federal subsidies for abortions. There was some question as to whether that provision might run afoul of Senate rules about what can be included in the bill in order for it to be passed by a simple majority vote of 51 rather than the 60-vote super-majority needed to approve most major legislation. Republicans are trying to use a procedure known as budget reconciliation to speed passage of the bill without the need for any Democratic support.

Many Republicans said they still had a lot of questions after they were briefed on the bill by their leaders.

"I don't think any of us can walk out and really speak clearly" about the bill's contents, said Sen. Bob Corker, R-Tenn.

"It's a significant piece of legislation and people have a lot of questions," he said.

Finance Committee Chairman Orrin Hatch, R-Utah, disputed criticism from Democrats and some Republican that there is not enough time to review the bill before a vote next week.

"You’ve got a lot of time; you’ve got tomorrow, and the next day, and the next day after that and then next after that. It doesn’t get any better than that,” Hatch said.

Contributing: Deirdre Shesgreen, Michael Collins

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