By Sean Sullivan, Kelsey Snell and Juliet Eilperin,
The Senate GOP’s push to rewrite the Affordable Care Act suffered an ill-timed setback Thursday, as two centrist Republicans announced plans to offer their own health care plan just as leaders released an updated bill of their own.
The move by Sens. Bill Cassidy (La.) and Lindsey O. Graham (S.C.) to debut their health-care proposal on CNN moments before Senate Majority Leader Mitch McConnell (R-Ky.) was set to brief members demonstrated how divided the majority remains in its quest to overhaul former president Barack Obama’s signature health care law.
In a joint interview with CNN Thursday, Cassidy and Graham said that they would take the billions of dollars the federal government now receives in taxes under the ACA and direct that revenue to the states.
“We’re gonna see which one can get 50 votes,” Graham said, referring to the number of GOP senators needed to approve any bill in the Senate, given that Vice President Pence is prepared to cast the tiebreaking vote. “We’re not undercutting him; he’s not undercutting us.”
“Our problem has been trying to combine tax reform with replacement of Obamacare,” said Cassidy. “We’re giving the money back to the states. The states can do what they want to do. A blue state can do a blue thing; a red state can do a red thing.”
The surprise announcement just before Senate GOP leaders released a revised health-care proposal Thursday that would allow insurers to sell austere plans that do not comply with requirements imposed under the Affordable Care Act.
Sen. Ted Cruz (R-Tex.), who authored the provision letting insurers offer minimalist coverage plans on the federal health-care exchange, said in a radio interview that the fact that the new draft “will include” a version of his amendment “is a very positive development.”
“I think we’re making serious progress toward coming together and unifying our conference,” said Cruz, who appeared on the 550 KFYI Phoenix radio host Mike Broomhead show along with Sen. Jeff Flake (R-Ariz.). Neither lawmaker has yet to endorse the GOP plan to rewrite the Affordable Care Act.
Details of the proposal were closely guarded Thursday morning, and it was unclear what precise form the Cruz idea would take in the final bill.
Cruz’s plan would allow insurers to sell plans that don’t comply with Obamacare coverage requirements, such as mandated coverage of preventive care and mental and substance abuse treatment, provided they offer at least one that does.
“What it is focused on, front and center, is lowering premiums,” Cruz said of his amendment. “You the consumer, should have the freedom to purchase the insurance you want.”
Critics, including insurers, believe that providing the option of skimpier plans would draw younger, healthier consumers into a separate risk pool. That development would drive up rates for the Americans buying more comprehensive coverage on the individual market, which could in turn destabilize the entire market.
Sen. John Thune (R-S.D.), a top McConnell deputy, said leaders are waiting for the Congressional Budget Office analysis next week before settling on what elements will be included in the final Senate bill. One option Thune raised was a fund to help offset the cost of premiums for people who would fall into high-risk pools under the Cruz plan. Thune said that money would “help shore up the markets,” but he declined to say how they would be structured.
“At this point I don’t think anything is final,” Thune said. “Not until we get on the bill next week and get to amend it.”
Senate leaders are also leaving themselves the option of jettisoning the Cruz proposal after they get the nonpartisan CBO score, that will gauge the Cruz amendment’s impact on both the budget and the overall number of uninsured.
McConnell is willing to preserve a pair of taxes on wealthy Americans that would have been repealed under the original bill to help subsidize the cost of middle-Americans’ premiums, according to several Republicans briefed on the bill. These lawmakers and aides said the revised bill would also provide $45 billion in funding to address opioid addiction — a key priority for GOP Sens. Rob Portman (Ohio) and Shelley Moore Capito (W.Va.).
Senate Majority Whip John Cornyn (R-Tex.) said Thursday that he expects the CBO will release two scores for the bill but would not confirm what those scores would include or when it will be released.
“We are expecting a CBO score but I can’t tell you exactly what the format will be,” Cornyn told reporters. “The Lee and Cruz amendment will be scored.”
The Cruz amendment underwent several iterations in recent weeks and the proposal is still being considered by analysts at the CBO, according to two GOP aides familiar with the process. As a result, the CBO is expected to release one score without the Cruz provisions and another that will provide further details on the Cruz amendment.
The changes remain controversial among moderates who worry the Cruz proposal could drive up premiums for sicker, older Americans. Cornyn stopped short of promising the changes would be enough to ensure the bill will pass.
“We will have the votes when we start voting,” Cornyn said.
In a sign of how undecided many GOP senators remain, Flake — who backs Cruz’s proposal — said in Thursday’s interview that he remains concerned about the large cuts to Medicaid funding contained in the bill.
“There is a lot of concern in Arizona on the Medicaid side,” said Flake, whose state expanded Medicaid to able-bodied, childless adults under the ACA and stands to lose billion in federal funds under the Senate bill. “This amendment does not affect the Medicaid side at all.”
The release will come a day after President Trump intensified public pressure on McConnell to shepherd the bill to passage, even as it remains unclear whether he will have the votes to do that next week, when he intends to bring it to the Senate floor.
“I am sitting in the Oval Office with a pen in hand, waiting for our senators to give it to me,” Trump said in an interview with televangelist Pat Robertson of CBN News. “It has to get passed. They have to do it. They have to get together and get it done.”
Conservative lawmakers and activists have voiced concerns that McConnell’s revamped measure will not undo the ACA, known as Obamacare, aggressively enough. Those worries, alongside lingering anxiety among centrist Republicans that the bill is going too far, has put McConnell at serious risk of losing more GOP votes than he can afford. If more than two GOP senators defect, the bill cannot pass.
Cruz has argued that his idea would provide consumers with more choice. But critics assert that it would lead to less healthy people ultimately paying more for coverage.
Sen. Bob Corker (R-Tenn.) said he believes McConnell will release two versions of the revised bill on Thursday — one with Cruz’s amendment and one without it. GOP leaders were more circumspect.
“It needs to be in the underlying text,” Cruz told reporters Wednesday, dismissing the suggestion that he could instead introduce it during an open amendment process if and when the bill heads to the Senate floor.
McConnell hopes to have a score on his revised bill from the CBO by the beginning of next week. The CBO will forecast what the bill will do to insurance coverage levels nationwide over the next decade. It will also predict the measure’s impact on the federal budget deficit.
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