McConnell Bets Medicaid Cuts Won’t Sink Obamacare Repeal

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.”