McConnell Bets Medicaid Cuts Won’t Sink Obamacare Repeal

The Senate majority leader made some concessions to both sides but did not soften the Medicaid cuts that many senators have criticized.

Sen. Susan Collins of Maine is surrounded by reporters on Capitol Hill Thursday after a revised version of the Republican health care bill was announced.
AP Photo/J. Scott Applewhite
July 13, 2017, 4:51 p.m.

Sen­ate Ma­jor­ity Lead­er Mitch Mc­Con­nell un­veiled a re­vised bill to “re­peal and re­place” the Af­ford­able Care Act Thursday, set­ting up a cru­cial vote next week on the Re­pub­lic­ans’ top pri­or­ity in Con­gress. But the bill main­tains deep cuts to Medi­caid, dar­ing a group of GOP sen­at­ors rep­res­ent­ing states that ex­pan­ded the pub­lic health pro­gram for low-in­come people to vote against it.

The bill rep­res­ents an ideo­lo­gic­al gamble by Mc­Con­nell, who de­cided to main­tain the Medi­caid cuts de­cried by mod­er­ates while ac­ced­ing to the wishes of two key con­ser­vat­ives, Sens. Ted Cruz and Mike Lee, by in­clud­ing lan­guage al­low­ing in­di­vidu­als to re­ceive tax cred­its to help them buy skim­pi­er plans than are cur­rently per­mit­ted un­der Obama­care.

Since two Re­pub­lic­an sen­at­ors—Susan Collins of Maine and Rand Paul of Ken­tucky—have already come out against the bill, Mc­Con­nell will have to run the table with every oth­er Re­pub­lic­an sen­at­or to get the 50 votes ne­ces­sary for pas­sage.

Collins, a mod­er­ate, cited the Medi­caid cuts as a ma­jor reas­on why she came out against the bill.

“I’m still deeply con­cerned about the Medi­caid cuts that are in­cluded,” said Collins. “They have been mod­i­fied in some ways, but there’s no doubt in my mind that there are hun­dreds of bil­lions of dol­lars of cuts in the Medi­caid pro­gram that would shift costs onto state gov­ern­ments.

“It would hurt the most vul­ner­able cit­izens,” she ad­ded. “It would have an ad­verse im­pact, par­tic­u­larly on our rur­al health care pro­viders, our hos­pit­als, and our nurs­ing homes. And it is not something that I can sup­port.”

The non­par­tis­an Con­gres­sion­al Budget Of­fice re­por­ted that a pre­vi­ous ver­sion of the bill would cut $772 bil­lion from Medi­caid over the next dec­ade, res­ult­ing in 15 mil­lion few­er people covered un­der the pro­gram. (An­oth­er 7 mil­lion more Amer­ic­ans would be un­in­sured due to re­forms to the in­di­vidu­al mar­ket.) The CBO will re­lease its score of the re­vised bill next week.

The Sen­ate Re­pub­lic­an bill, known as the Bet­ter Care Re­con­cili­ation Act, ad­ded an ad­di­tion­al $70 bil­lion to the ori­gin­al $112 bil­lion to prop up the in­di­vidu­al mar­ket, which could help at­tract the sup­port of some sen­at­ors. But the bill would still dra­mat­ic­ally re­form Medi­caid from an open-ended en­ti­tle­ment to a capped or block-grant sys­tem, and even­tu­ally roll back the ex­pan­sion un­der the ACA. A group of sen­at­ors rep­res­ent­ing ex­pan­sion states, in­clud­ing Sens. Rob Port­man of Ohio, Shel­ley Moore Capito of West Vir­gin­ia, Dean Heller of Nevada, and John Ho­even of North Dakota huddled with Mc­Con­nell on Thursday af­ter­noon. Those four sen­at­ors op­posed the pre­vi­ous ver­sion of the bill.

On Thursday, some of these sen­at­ors stated that they were un­de­cided on even a pro­ced­ur­al vote to ad­vance the bill for­ward.

Heller, who had come out force­fully against the first draft of the health care bill, told re­port­ers on the way out to his car Thursday even­ing that he was also un­de­cided. “There will be a lot of meet­ings, and it will in­clude dis­cus­sions with the gov­ernor,” he said. But he would not say wheth­er he would sup­port the bill if Nevada Gov. Bri­an San­dov­al op­poses it.

San­dov­al, the in­com­ing chair of the Na­tion­al Gov­ernors As­so­ci­ation, told Na­tion­al Journ­al Thursday that he had not had a chance to re­view the bill but that fund­ing for Medi­caid “has been a pri­or­ity for me, to pro­tect the 200,000-plus lives that be­ne­fit as a res­ult of the ex­pan­sion.”

Sen­at­ors will have the op­por­tun­ity to change the bill through amend­ment. The Medi­caid-ex­pan­sion-state sen­at­ors want to in­crease per-en­rollee pay­ments through Medi­caid; cur­rently the bill would even­tu­ally peg the for­mula to con­sumer rather than med­ic­al in­fla­tion, which grows faster. But oth­er con­ser­vat­ives have ob­jec­ted. The ori­gin­al bill would re­duce the de­fi­cit by $321 bil­lion over a dec­ade, in large part due to the Medi­caid cuts, ac­cord­ing to CBO.

On Thursday, Sen. Bill Cas­sidy of Louisi­ana noted that the sig­ni­fic­ant changes to the Medi­caid growth rate be­gin in 2025. “If it doesn’t work, we have eight years to kind of fig­ure that out,” he said.

Over­all, the Sen­ate’s pro­cess to re­form health care has been se­cret­ive, shun­ning con­gres­sion­al hear­ings and oth­er meas­ures that al­low the de­bate to be ana­lyzed be­fore the pub­lic. The closed-door ne­go­ti­ations have res­ul­ted in a bill cri­ti­cized by ma­jor hos­pit­al, doc­tor, and pa­tient-ad­vocacy groups. In June, mul­tiple polls showed few­er than 20 per­cent of re­spond­ents sup­port­ing the Sen­ate bill.

On Thursday, AARP, the largest non­profit ad­vocacy group for those above the age of 50, was one of mul­tiple out­side groups that blas­ted the re­vised bill.

“AARP also re­mains alarmed at the Sen­ate bill’s drastic Medi­caid cuts,” said AARP Ex­ec­ut­ive Vice Pres­id­ent Nancy Lea­Mond in a state­ment. “The pro­posed cuts would leave mil­lions of Amer­ic­ans, in­clud­ing 17.4 mil­lion poor seni­ors and people with dis­ab­il­it­ies, at risk of los­ing the care they need and their abil­ity to live in­de­pend­ently in their homes and com­munit­ies.”

Zach C. Cohen contributed to this article.
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