Senate GOP brings Obamacare repeal bill out of the shadows

After weeks of work behind closed doors, the GOP released its plan and will try to find the votes to pass it.

By Adam Cancryn , Burgess Everett and Jennifer Haberkorn, June 22, 2017

Mitch McConnell wants to cut and cap Medicaid

Senate Majority Leader Mitch McConnell arrives on Capitol Hill as Senate
Republicans work on a health reform bill on on June 22, 2017.
(Andrew Harnik/AP Photo)

Senate Republican leaders unveiled their long-secret plan to repeal Obamacare on Thursday, giving GOP senators and the public the first glimpse at a bill that would rewrite the nation’s health care system.

The broad contours of the 142-page bill — which would tear down large parts of the 2010 health law, cap one of the nation’s biggest entitlement programs and overhaul one-sixth of the U.S. economy — have come into focus in recent days.

But GOP senators trickling out of an all-conference meeting this morning said while the reaction was broadly positive, it amounted to just an initial step toward winning over a host of still-skeptical lawmakers.

"A lot of questions," Sen. Richard Burr (R-N.C.) said of the closed-door session. "But there wasn't paper. Until they get a chance to read it, I'm sure they won't firm up."

Majority Leader Mitch McConnell is pushing for a vote as early as next Thursday, ahead of Congress’ July 4 recess and before more opposition can mount.

Since Democrats are unified in their resistance, Republicans are using a fast-track process that can evade filibusters.

GOP leaders need the support of at least 50 of the chamber’s 52 Republican senators to pass the bill, and several this week said they’re withholding their support until they see final legislation. Thursday’s meeting represented the “start of the process” of getting requisite votes, Senate Majority Whip John Cornyn (R-Texas) said Wednesday.

“We’ve been talking about these concepts for a long time. This is an attempt to bring us to … how we resolve the differences and achieve consensus. I think it’s going to be very detailed,” Cornyn said.

It won’t immediately be clear if McConnell has the votes until sometime next week, after a Congressional Budget Office analysis illustrates how many fewer Americans are likely to be insured by the bill and answers the crucial political question of whether premiums would be reduced.

And the proposal  blandly dubbed the Better Care Reconciliation Act of 2017 is likely to change somewhat before next week’s vote as senators engage in last-minute negotiations on the legislation.

The repeal plan eliminates Obamacare’s mandates and hundreds of millions of dollars in taxes on the wealthy and the health industry. The bill also would kill Obamacare's Medicaid expansion and impose significant cuts to the long-term Medicaid program. It keeps the structure of Obamacare's insurance subsidies to help low-income people buy insurance, but tweaks them to cover only those making up to 350 percent of the federal poverty line — down from the 400 percent covered under Obamacare.

The bill also bars the use of subsidies for plans that include abortion coverage, though some Republicans have said that the provision may not survive due to the Senate's strict procedural rules under reconciliation. Planned Parenthood would be defunded for one year.

In a bid to win the support of senators from states that expanded Medicaid — many of which face opioid crises — it provides $2 billion in fiscal year 2018 to fund substance abuse and mental health programs.

Republicans are hoping for broader buy-in from the healthcare industry Thursday than the House bill received, some senators said. Republicans also said they expected the bulk of the caucus will endorse the bill immediately, with leadership allies expected to give the legislation a quick jolt of momentum.

“We’ll have some people who will say: ‘I’ll vote for it immediately,’ because they realize that failing to do anything will be very disastrous for the people that are hurt by the meltdown of Obamacare,” Cornyn said. “Others are going to have specific concerns that we’re going to have to talk our way though.”

Indeed, conservatives, moderates and senators from Medicaid expansion states all remained on the fence even after coming out of the meeting.

"By the time I get back to my office I'm told I'll have a copy," said Sen. Lisa Murkowski (R-Alaska), a key moderate swing vote. "There was no paper. ... I want to get back to my office and actually take a look at it."

Still, the cajoling has begun early, with Sen. Ted Cruz (R-Texas) spotted working Sen. Mike Lee (R-Utah) during a Wednesday afternoon vote. And President Donald Trump dialed up Sen. Rand Paul (R-Ky.) on Tuesday to take his temperature.

Republicans will allow states to opt out of some of Obamacare’s insurance requirements, including one requiring states to have an exchange, as well as rules for what benefits insurers must cover, what qualifies as a health plan, and the actuarial value of the plans.

The bill won't allow states to waive Obamacare requirements that insurers accept everyone and charge the same rates, with few exceptions. The House waived the latter requirement, triggering a storm of criticism that it was abandoning people with pre-existing conditions. Keeping those Obamacare requirements would mark a victory for GOP moderates but prompt pushback from conservatives, who want the waiver to be broader and allow more exclusions.

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