WASHINGTON — The revised health bill unveiled by Senate Majority Leader Mitch McConnell on Thursday allows insurers to offer low-cost scaled-back plans, retains two taxes on the wealthy, and adds funds to make insurance more affordable and to fight opioid addiction.
With those changes to the legislation that he pulled from a vote two weeks ago, McConnell hopes to secure the 50 votes he needs from his 52-member caucus after conservative Sen. Rand Paul, a fellow Kentuckian, and moderate Sen. Susan Collins (R-Maine) said they can’t support it.
“It’s time to rise to the occasion,” McConnell said on the Senate floor after presenting the new version to his caucus members in a closed-door meeting at the Capitol, reminding them of Republicans’ seven-year promise to repeal Obamacare.
Passage of the 172-page bill next week is uncertain, with the solid opposition by Democrats and the wavering of factions of conservatives and more moderate Republicans, whose lack of support forced McConnell to add measures to appease both sides.
President Donald Trump said Wednesday he would be “angry” if the Senate does not pass the bill, but later he told reporters flying to Paris with him on Air Force One that “the only thing more difficult than peace between Israel and the Palestinians is health care.”
As if to prove his point, Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana pre-empted McConnell by offering an alternative bill to turn federal health spending into block grants, to give states the role of deciding how to provide health coverage.
A Senate summary of the revisions said the bill would lower premiums and medical costs — by allowing insurers to offer lower-cost plans that don’t provide all of Obamacare’s required benefits and permitting the use of health savings accounts to pay for insurance.
The bill adds $70 billion to a $112 billion fund for states to use to bring down costs for lower-income families, and sends $45 billion in grants to states to deal with opioid addiction.
To pay for that funding, the bill reverses course from its first draft by keeping Obamacare’s 3.8 percent tax on investment income and 0.9 percent payroll tax for families making $250,000 or more, as well as Obamacare’s tax on the highest-paid insurance executives.
Several senators emerging from the meeting told reporters they were undecided about whether they could support the new bill. Others said they would vote to move it to a full debate, amendment process and a final vote later next week. Collins and Paul remained opposed to it.
“There’s a discussion still going on. Everybody’s asking questions. Those are being answered, discussed and points being made,” said Sen. John Thune (R-S.D.), part of McConnell’s leadership team. “I think that’s probably going to continue for a while.”
Sen. Pat Toomey (R-Pa.) said, “While I support this draft in its current form, it is not perfect. I am disappointed that the commitment to repeal all of Obamacare’s taxes was abandoned.”
Collins remained opposed to both moving the new bill forward and supporting it. She said its rewrite of Medicaid rules deserved at least one Senate hearing, and that Republicans shouldn’t make Democrats’ mistake in passing a sweeping health care bill without bipartisan support.
She said she also objects to the bill’s cap on federal spending for Medicaid and a rate for future funding that is lower than inflation for medical expenses, thereby shifting costs to the states.
“It would hurt the most vulnerable citizens. It would have an adverse impact particularly on our rural health providers, our hospitals and our nursing homes,” she said. “And it is not something that I can support.”
The first test for McConnell’s bill will come early next week. After the Congressional Budget Office estimates costs and insurance coverage of the new bill early next week, the Senate will hold a vote on whether to proceed to debate, amendments and a final vote.
McConnell needs 50 votes and Vice President Mike Pence’s tie breaker to surmount that hurdle. And he’ll need 50 votes to enact the bill; he cannot afford to lose the support of another senator.
Highlights of changes
Here’s a look at some of the latest changes to the Senate Republican health care bill.
- A major change to health savings accounts would allow consumers to use the tax-sheltered arrangements to also pay for health insurance premiums. Currently HSAs can be used to pay only out-of-pocket costs not covered by insurance.
- More money for states to help lower insurance costs for residents who buy their own individual policies. The bill would add another $70 billion to a market stability fund of $112 billion in the original Senate bill.
- Another $45 billion over 10 years for states battling the opioid epidemic, targeted to paying for substance abuse treatment and recovery. The original bill provided only $2 billion.
- More ways for consumers to buy lower-premium, bare-bones insurance. Consumers could use their federal tax credits to buy high-deductible plans that cover three routine doctor visits per year. Current limits on who can use federal tax credits to purchase so-called catastrophic insurance would be eased.
- A version of Texas Sen. Ted Cruz’s proposal allowing insurers to sell skimpy plans, provided they also offer at least one option that meets the requirements of current law. The latest approach would provide funding for insurers to help offset the cost of covering sicker people remaining in comprehensive plans.