Senate Republican leaders unveiled their long-secret plan to repeal Obamacare on Thursday, giving GOP senators and the public the first glimpse at a bill that would rewrite the nation’s health care system.
GOP leaders still face huge hurdles in getting the bill passed next week, but the plan got a warm reception from Republicans after they were briefed Thursday morning.
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"It’s a good beginning," said Sen. John McCain (R-Ariz.). "The status quo is unacceptable."
The broad contours of the 142-page bill — which would tear down large parts of the 2010 health law, cap one of the nation’s biggest entitlement programs and overhaul one-sixth of the U.S. economy — have come into focus in recent days. Majority Leader Mitch McConnell is pushing for a vote as early as next Thursday, ahead of Congress’ July 4 recess and before more opposition can mount.
But McConnell is still short the 50 votes he needs to pass the bill, with several senators saying they’re withholding their support until they see and and have adequate time to evaluate the final legislation.
“I don’t think I’ll have the information — to be able to solicit all the input I believe I should do in terms of due diligence to be able to vote yes on this,” Sen. Ron Johnson told POLITICO. “It takes time.”
Since Senate Democrats are unified in their resistance, Republicans are using a fast-track process that can evade filibusters. But they can only afford two defections and still maintain the thin majority needed to pass the repeal bill.
Senate Minority Leader Chuck Schumer and other Democrats immediately took to the floor to blast the plan.
“The president said the Senate bill needed heart,” he said. “The way this bill cuts health care is heartless. The president said the House bill was mean. The Senate bill may be meaner.”
When asked if the Senate plan has enough heart at a White House event Thursday, President Donald Trump replied, “A little negotiation, but it’s going to be very good.”
The Congressional Budget Office hasn’t yet weighed in on how many fewer Americans are likely to be insured under the Republican plan, or answered the crucial political question of whether premiums would be reduced. That report is expected by early next week, setting up a sprint to gather votes ahead of a potential late-week vote.
The House bill, whose fundamental framework can be seen in the Senate plan, would leave 23 million fewer Americans insured over the next decade, according to CBO.
The Senate bill — blandly dubbed the Better Care Reconciliation Act of 2017 — eliminates Obamacare’s mandates and hundreds of millions of dollars in taxes on the wealthy and the health industry. Notably, it doesn’t impose any new requirement that people purchase or maintain coverage — a major element that Republican leaders said they’re still working on.
The bill also would phase out Obamacare’s Medicaid expansion over three years beginning in 2021 and would make deep cuts to the long-term Medicaid program. It keeps the structure of Obamacare’s insurance subsidies to help low-income people buy insurance, but tweaks them to cover only those making up to 350 percent of the federal poverty line — down from the 400 percent covered under Obamacare.
The bill bars the use of subsidies for plans that include abortion coverage, though some Republicans have said that the provision may not survive due to the Senate’s strict procedural rules under reconciliation. Planned Parenthood would be defunded for one year.
Obamacare’s $1 billion Prevention and Public Health Fund, which was designed to tackle threats like Zika and pay for preventive health services, would be eliminated by 2018.
Senate Republicans would allow states to opt out of some of Obamacare’s insurance requirements, including one requiring states to have an exchange, as well as rules for what benefits insurers must cover, what qualifies as a health plan, and the actuarial value of the plans. Those waivers are aimed at loosening oversight of insurers and paving the way toward even lower premiums, though they could also prompt insurers to dramatically cut benefits and increase deductibles.
The bill won’t allow states to waive Obamacare requirements that insurers accept everyone and charge the same rates, with few exceptions. The House waived the latter requirement, triggering a storm of criticism that it was abandoning people with pre-existing conditions.
Republicans are hoping for broader buy-in from the healthcare industry Thursday than the House bill received, some senators said. But the bill’s fate will rest on how factions on either end of the conference’s ideological spectrum react to the bill’s sweeping proposals.
Indeed, conservatives, moderates and senators from Medicaid expansion states all remained on the fence even after coming out of the meeting.
"By the time I get back to my office I’m told I’ll have a copy," said Sen. Lisa Murkowski (R-Alaska), a key moderate swing vote. "There was no paper. … I want to get back to my office and actually take a look at it."
Along with other Medicaid expansion-state senators, like Ohio’s Rob Portman and West Virginia’s Shelley Moore Capito, Murkowski is worried about the consequences of cutting off Obamacare’s enhanced funding so quickly, and pushed instead for rolling back expansion over as many as seven years.
Murkowski and Sen. Susan Collins have also warned against defunding Planned Parenthood as part of the bill, and expressed reservations about the impact certain provisions may have on elderly Americans’ ability to afford coverage.
And among conservatives, there remain serious concerns over whether the repeal bill amounts to a "true" repeal of Obamacare and the regulations it imposes on the health care system.
Sen. Rand Paul said that he and other senators — he declined to name them — would have a statement this afternoon on the bill. The Kentucky Republican refused to share details but said the bill doesn’t repeal enough of Obamacare.
Sen. Ted Cruz is pushing for an amendment to allow catastrophic, low premium plans, but it’s not clear if the parliamentarian will allow them, according to Republicans.
Senate Republican leaders have spent the last few weeks trying to manage that delicate ideological balance, in hopes of charting a narrow path to 50 votes
Still, Republicans said Thursday’s all-conference meeting demonstrated there are still a number of issues yet to be solved.
"It’s obviously a discussion draft," said Sen. John Thune (R-S.D.). "So we’ve got members who are going to be interested in looking at the text and see what they can do to refine, improve and dial things accordingly to try to figure out how we get 50 votes."
Brianna Ehley, Rachana Pradhan and Rachael Bade contributed to this report.