Revised Senate health-care bill still lacks the votes to pass

By Sean Sullivan, Kelsey Snell and Juliet Eilperin
July 13 at 2:21 PM - The Washington Post

The Senate GOP�fs latest attempt to rewrite the Affordable Care Act showed few signs of gaining traction Thursday, further imperiling the party�fs quest to overhaul Barack Obama�fs 2010 health-care law.

At least three Republican senators said Thursday they remained opposed to bringing up the revised bill, while two rank-and-file Republicans announced plans to offer their own health-care plan just as leaders released an updated bill of their own. Senate leaders need the support of 50 of their 52 members to pass the legislation.

Senate Majority Leader Mitch McConnell (R-Ky.) offered a new draft aimed at meeting specific requests of GOP senators reluctant to support the measure previously.

The new measure has won the backing of Sen. Ted Cruz (R-Tex.), whose proposal to allow insurers to sell austere plans that do not comply with ACA requirements was included in the latest draft. But Sen. Rand Paul (R-Ky.), who says the measure still does not do enough to unravel the law known as Obamacare, remains opposed to voting on the bill, as do two centrists, Sens. Susan Collins (R-Maine) and Rob Portman (R-Ohio).

�gMy strong intention and current inclination is to vote no on the motion to proceed,�h Collins told reporters.

Portman, who came out against the original draft of the bill, also said he was opposed to taking a vote at this point. �gI�fm in the same position I�fve been in, looking at the language and looking forward to the analysis,�h he said.

The three senators�f continued opposition, coupled with the move by Sens. Bill Cassidy (R-La.) and Lindsey O. Graham (R-S.C.) to debut their health-care proposal on CNN moments before McConnell was set to brief members, demonstrated how divided the majority remains in its quest to overhaul Obama�fs signature health-care law.

Graham said that he would vote for a procedural motion to start debate on the bill but that he is still working on changes to make the legislation more palatable for states such as Nevada, which accepted Medicaid expansion.

�gI�fm trying to get a bill that will lock down Republican governors,�h Graham told reporters after his caucus met behind closed doors.

In a joint interview with CNN on 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.

�gWe�fre going to see which one can get 50 votes,�h 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. Referring to McConnell, he added, �gWe�fre not undercutting Mitch; he�fs not undercutting us.�h

The surprise announcement came just before Senate GOP leaders released a revised health-care proposal Thursday. The updated measure also allows Americans to pay for premiums with money from tax-exempt health savings accounts (HSAs), an idea that many conservatives pushed, along with more-generous subsidies to offset consumers�f out-of-pocket health costs and treat opioid addiction.

Cruz told reporters that allowing Americans to use their HSAs to pay for premiums equates to �geffectively a reduction in your rates of 20 to 30 percent, immediately.�h

Cruz, who appeared on Phoenix�fs KFYI radio along with Sen. Jeff Flake (R-Ariz.) on Thursday morning, predicted that the new draft would bring other members along.

�gI think we�fre making serious progress toward coming together and unifying our conference and getting a bill that can command the support of at least 50 senators and pass into law,�h he said.

Cruz�fs plan would allow insurers to sell plans that don�ft 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.

�gWhat it is focused on, front and center, is lowering premiums,�h Cruz said of his amendment. �gYou, the consumer, should have the freedom to purchase the insurance you want.�h

Critics, including insurers, say 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.

The revised bill would establish a fund to subsidize insurers providing both kinds of plans �gfor the associated costs of covering high-risk individuals,�h according to a GOP summary of the bill. It would also allow individuals buying catastrophic plans to get a federal tax credit if they would be otherwise eligible, which is now barred under current law.

It provides $70 billion to an existing $112 billion state stabilization fund aimed at helping offset consumers�f costs, as well as a $45 billion fund to treat opioid addiction sought by Portman and Shelley Moore Capito (R-W.Va.).

Republicans financed these changes by keeping a trio of Obamacare taxes targeting high earners. Lawmakers such as Sen. Bob Corker (R-Tenn.) said repealing those taxes would give too much relief to the wealthy at the expense of the poor. They include a 3.8 percent tax on net investment income and a 0.9 percent Medicare payroll tax on individuals making $200,000 a year or couples earning $250,000, along with a tax on insurers with high-paid executives.

Even with these changes, a number of moderate Republicans said that they remain undecided about the legislation. Cassidy and Sen. John Hoeven (R-N.D.), for example, said they need to see the Congressional Budget Office score before making a decision. Senate leaders expect to get numbers from the CBO early next week.

�gWe are going to look at it, read it, understand it and see the CBO score,�h Hoeven told reporters. �gAt this point, I�fm reserving judgment.�h

Hoeven said he was encouraged by changes made to help lower-income people afford the cost of their premiums but wants to see estimates of how many people stand to lose coverage under the revised legislation.

Sen. John Thune (R-S.D.), a top McConnell deputy, said leaders are waiting for the CBO analysis next week before settling on what elements will be included in the final Senate bill.

�gAt this point, I don�ft think anything is final,�h Thune said. �gNot until we get on the bill next week and get to amend it.�h

Senate leaders are also leaving themselves the option of jettisoning the Cruz proposal after they get the nonpartisan CBO score, which will gauge the Cruz amendment�fs impact on the budget and the overall number of uninsured.

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.

�gWe are expecting a CBO score, but I can�ft tell you exactly what the format will be,�h Cornyn told reporters. �gThe Lee and Cruz amendment will be scored.�h

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.

�gWe will have the votes when we start voting,�h Cornyn said.

In a sign of how undecided many GOP senators remain, Flake — who backs Cruz�fs proposal — said in Thursday�fs interview that he remains concerned about the large cuts to Medicaid funding contained in the bill.

�gThere is a lot of concern in Arizona on the Medicaid side,�h said Flake, whose state expanded Medicaid to able-bodied, childless adults under the ACA and stands to lose billions in federal funds under the Senate bill. �gThis amendment does not affect the Medicaid side at all.�h

The revised draft does, however, include a provision stating that in the case of a public-health emergency, Medicaid spending wouldn�ft count toward the per-capita caps imposed by the bill.

The release comes 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.

�gI am sitting in the Oval Office with a pen in hand, waiting for our senators to give it to me,�h Trump said in an interview with televangelist Pat Robertson of CBN News. �gIt has to get passed. They have to do it. They have to get together and get it done.�h