Senate Republican leaders revealed their closely guarded health care bill on Thursday, predictably outraging Democrats and leaving some conservative senators insistent that the bill doesn’t go far enough.
Known officially as the Better Care Reconciliation Act of 2017, the legislation kills Obamacare’s individual mandate, scraps many of the current taxes on the books, and gives more power to the states to define the health care market.
On the flip side, the bill increases subsidies over what House Republicans approved last month and offers a slower phasing out of Medicaid expansion. Both plans keep the Obamacare provisions of forbidding insurance companies from rejecting patients with pre-existing conditions and allowing young adults to stay on their parents’ policies until age 26.
Some of the top conservative health care policy leaders are effusive in their praise. Foundation for Research on Equal Opportunity President Avik Roy says, “If it passes, it’ll be the greatest policy achievement by a GOP Congress in my lifetime.”
Galen Institute President Grace-Marie Turner also likes the plan, noting that it addresses the four areas she believes must be dealt with as a result of Obamacare’s many problems. Specifically, she says any final product must provide a safety net, create a bridge to new coverage, allow states greater flexibility on regulations, and reform Medicaid.
“This bill does all four of those key things,” said Turner. “Yes the Senate moves the dials in slightly different ways and they learned from the reaction to the House bill, particularly in the way the refundable tax credits were structured for people who need help in purchasing coverage.”
Turner admits the Senate bill spreads taxpayer dollars around more liberally than the House plan.
“Young people, people that are in lower income categories and people (nearing) Medicare age will get more help than they would have through the House bill,” said Turner.
That approach extends to Medicaid as well.
“It gets back to a more normal way of spending the federal-state match for Medicaid spending, but it does it over a longer period of time. So the states have more time to adjust to reductions in their Medicaid payments,” said Turner.
“But they are also going to have a lot more flexibility with this bill than they would have otherwise had. Obamacare just basically added millions more people to a faltering Medicaid program instead of building in reforms,” she added.
While many on the right see the legislation as a significant improvement over the status quo, some changes must be made if Republican leaders want the votes needed to pass it. Sens. Ted Cruz, R-Texas, Mike Lee, R-Utah, Rand Paul, R-Kentucky, and Ron Johnson, R-Wisc., say they cannot back the bill in its present form because it doesn’t do what the GOP promised to do the past four election cycles.
“Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor,” the senators said in a joint statement.
“There are provisions in this draft that represent an improvement to our current healthcare system but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their healthcare costs,” they added.
Turner says she is encouraged by the language of the statement and expects their concerns to result in a stronger bill.
“I think the leadership knows they are going to have to make tweaks and adjustments to this bill. Fortunately, we’re now sort of out of the policy realm and we’re in the vote-buying realm. ‘What do you need, Sen. Paul? What do you need Sen. Johnson, etc. to be able to vote for this bill,” said Turner.
“We saw on the House side they made it better when people started to push back strongly,” said Turner.
She also says the underlying arguments from the four senators are spot on but she says the parameters for moving this legislation make things more complicated.
“They are right that we’ve got to do more to get costs down and to give people more choices. But they’re also so constrained by this process they have to go through, this reconciliation process, to be able to pass this with 51 votes, means that everything in the bill has to directly pertain to federal spending and federal taxation,” said Turner.
“That means that it’s really hard to get to the regulatory structures through this bill, which is why I think we need to think about this as a first step – breaking the logjam – so we can begin a process of making changes that effect this one-sixth of our economy so that we can begin to move forward to give people the choices that they want. but we can’t do it on the Obamacare platform,” said Turner.
Turner says with Medicare and Medicaid on the books, the conservative goal of wrenching health care away from the clutches of government will remain just that. However, she says the key provisions allowing more latitude to the states is a major step in the that direction.
“There’s always going to be a federal footprint. The question is whether it’s Bigfoot and it crushes the health sector or whether it has an appropriate footprint of helping people in need while allowing the private market to work,” said Turner.
The greatest howls of protest came from Democrats, who denounced the bill as cruel and likely to kill many people the moment it was released.
“That sort of tells me they were against it before they even knew what was in it,” said Turner.
While fully aware of the partisan divide in Washington and the Democrats’ intention to defend President Obama’s signature domestic achievement, Turner is stunned that Democrats are fine with what Obamacare is doing to health care right now.
“Are they really defending Obamacare, that has caused health insurance costs to double for an individual since the year before this law was passed, 140 percent higher for families. You have many counties that are at risk of having no options for people to use. Obamacare has not worked,” said Turner.
“There have been no changes in any meaningful way, other than one regulation, for the Trump administration or this Congress to precipitate this. This is failing of its own right,” said Turner.
Given the current numbers in the Senate, Turner believes this legislation is about the best the GOP can do on its own and that lawmakers must act.
“This is a rescue effort and they’ve got to get this done,” she said.