WASHINGTON — Senate Republicans are preparing to unveil a revised health care bill that aims to attract support from wary Republicans, but early indications suggest the proposed changes do little to address concerns about the current deep cuts to Medicaid, possibly putting the bill’s path to passage in peril.
Numerous changes have been made to the new version of the Better Care Reconciliation Act to appease both conservative and moderate Republicans as leadership searches for the 50 votes they need to pass it. In a blow to the more moderate faction, it appears the more than $700 billion worth of cuts to Medicaid will still be part of the measure, according to numerous senators describing what leadership has told them about the bill.
"My understanding is that remains the same," Sen. Pat Toomey, R-Penn., a proponent of the Medicaid cuts, said of the Medicaid portion of the bill.
Things could still change as the bill’s contents are yet final and the new text is expected to be released Thursday. Still, the prospects of creating a more generous Medicaid program appear to be dim. Republican leaders have used their effort to alter the Obama-era Affordable Care Act as an opportunity to reform the entitlement program for the low-income, the disabled and the elderly.
Some conservatives, including Toomey, have championed the cuts and have threatened to oppose the measure if they are reduced. Additionally, the White House, led by Vice President Mike Pence, supports how the program is laid out in the original BCRA.
Other senators have said that the cuts to Medicaid are too drastic to support the bill, including Sens. Rob Portman, R-Ohio, and Shelley Moore Capito, R-W.Va., Dean Heller, R-Nev., Susan Collins, R-Maine and Lisa Murkowski, R-Alaska.
Sen. Capito said that leadership hasn't given her assurances that her Medicaid concerns would be addressed. She said that leaders are telling them that they're "trying to get to the sweet spot of 50 people and (they are) expressing difficulties that obviously we know are there.”
To accommodate people who might lose their Medicaid coverage, Republicans have added $70 billion to a stabilization fund to help lower-income people pay for medical costs, also known as cost-sharing reductions. Moderates will have to determine if that’s enough for them to support the measure.
Senate Majority Leader Mitch McConnell can only lose the support of two of the 52-member Republican conference to pass a bill. On Tuesday, McConnell announced that the month-long Senate recess scheduled to begin at the end of July would be delayed for two weeks to allow more time to work on the health care bill and other agenda items.
McConnell needs every vote he can get on the measure. Sen. Rand Paul, R-Ky., came out Wednesday saying he'd vote against it because he said it doesn't come close to a repeal of the Affordable Care Act.
"This bill is no longer a repeal and they’re being asked to vote for something that we never promised," Paul said.
Some of moderates’ concerns have been addressed, however, including a $45 billion fund to help people with opioid addiction and the extension of a 3.8 percent tax on the wealthy first implemented under the Affordable Care Act, giving Republicans an estimated $170 billion over 10 years to fund their health care bill. Eliminating those taxes has been a prime goal of many conservative members of the House and Senate, but Democrats have hammered the bill for cutting benefits for the poor while bestowing more money on the rich.
To reflect the position of conservative Republicans, the new version allows people to use their Health Savings Accounts to pay for insurance premiums. Because HSA’s are derived from pre-tax dollars, experts amount this as a benefit for the higher-income Americans who are more likely to have health savings accounts. Republican leaders are looking closely at a proposal from conservative senators that would allow states to offer non-compliant health care plans in the individual market, ensuring a cheaper option that doesn’t offer comprehensive coverage.
But opposition from a critical industry could hamper the measure authored by Sens. Ted Cruz, R-Texas, and Mike Lee, R-Utah. The trade group representing health insurance companies, AHIP, has come out against it, saying that it would create “instability” in the individual market and that it will result in “higher premiums and lower enrollment.”
The proposed cuts to Medicaid would start in 2021 as the Obamacare expansion, which covered people earning up to 138 percent of the poverty level, begins to wind down. Deeper cuts go into effect in 2025 because of a change to the funding formula to the inflation rate, which rises much slower than the cost of health care, which will likely result in less coverage. The Congressional Budget Office, which analyzes Congressional legislation, estimated that the bill would create more than $700 billion worth of cuts to the program over 10 years and 15 million people would lose access to the program.
Medicaid proponents, however, could have one last chance if McConnell doesn't include their suggestions on Medicaid. If the measure is brought up for a debate, it is possible that amendments could be offered to scale back some of the cuts to the program.