WASHINGTON — The latest legislation in a Republican-led effort to reform health care would fund more substance abuse treatment and give fewer tax breaks to wealthy families.
Senate leaders say the first vote on the bill will take place next week. However, several reluctant Republican senators remain undecided about the legislation, making a path forward unclear.
The bill, called the Better Care Reconciliation Act, is the fourth attempt in Congress to repeal and replace the Affordable Care Act—the 2010 health care reform law also known as Obamacare.
Senate Republicans first released their response to a House-passed health care bill in June. Senate leaders initially planned to bring forward an earlier version of the legislation for a vote before lawmakers adjourned for the July 4 holiday, but the schedule was dashed when several Republicans said they would not support it.
The new proposal, expected to make concessions to entice support from dissenting senators, has been hotly anticipated in Congress and across the country.
Dozens of reporters milled in the hallway outside majority leader Mitch McConnell’s office as the Kentucky Republican met with other members of his caucus to go over the revised proposal.
After the meeting, McConnell addressed the latest version of the proposal on the Senate floor, where he blasted the Affordable Care Act and touted the new version of legislation repeal it.
“The revised draft improves on the previous version in a number of ways, all while retaining the fundamental goals of providing stability and improving affordability,” McConnell said.
The newest version of the bill has many of the same hallmarks as the previous bills. It would cut hundreds of billions of dollars nationwide from the Medicaid program over several years, allow insurance companies to offer fewer benefits to customers, and encourage people to use health savings accounts.
Medicaid patients would not be able to use their insurance at Planned Parenthood for one year. States would be able to change a major consumer protection that required insurance companies to spend at least 80 percent of premium money on health care, not administration or profits.
However, the newest version of the bill would make some changes that Republican senators have requested in the past. The bill would give states another $45 billion in Medicaid money fund substance abuse treatment and $70 billion in additional Medicaid money for health care reform.
The bill would allow people to use health savings accounts to pay for their health insurance, so they would be able to pay using pre-tax money even if their employer does not provide them health insurance. People of all ages — not just under 30 — would be able to buy catastrophic insurance plans.
The bill would also keep Obamacare taxes on families making $250,000 or more and a tax on investment income. There would still be tax breaks for pharmaceutical companies, medical device manufacturers, insurance companies, and tanning salons, among others.
Economists have estimated that a previous version of this bill would leave 22 million people without health insurance. Vermont health care leaders have estimated that up to 60,000 Vermonters could lose their insurance under previous versions of the bill.
Support for the bill uncertain
To take up the bill, the Senate will vote on a procedural motion. McConnell said that vote will happen next week.
Whether McConnell will find enough support within his caucus to bring the bill to the floor is not yet clear. Already, two Republicans have said they will vote against it: Sens. Rand Paul, R-Ky., and Susan Collins, R-Maine. Others told reporters they had not yet decided.
Divisions within the caucus were further illustrated as two Republican senators — Lindsey Graham, R-S.C., and Bill Cassidy, R-La. — worked on an alternative health care bill.
Meanwhile, Democrats and independents remained staunch in their opposition to the Republican measure. Both Vermont senators vowed to vote against the proposal after it was unveiled Thursday.
Speaking on the Senate floor, Sen. Bernie Sanders, I-Vt., said the bill “remains an embarrassment,” and noted there have been no public hearings on the legislation.
He said the impact of the proposed cuts to Medicaid is not fully understood.
“There is some belief that many rural hospitals in areas where they are desperately needed will be forced to shut down. Is that the truth? That’s what I hear,” Sanders said. “But I can’t tell you definitively,” he said, because there have not been hearings on that issue.
After coming off the floor, Sanders said his focus over the next week “is to do everything that I can to defeat this disastrous proposal.”
In the “not too distant future,” Sanders said he plans to introduce a bill to establish a single-payer program, and he believes support for such a system is “growing rapidly.”
“It is becoming harder and harder to defend the fact that we pay far more per capita for health care than any other, people of any other country,” he said.
Sen. Patrick Leahy, D-Vt., blasted the proposal in a statement as “a stumbling, shameful and craven exercise to pass a tax bill in the guise of a health care bill.”
“It is way past time for Senate Republicans and this White House to stop this reckless exercise and work with us to find ways to bring lifesaving health care to more Americans, not to fewer families, as the Republican plan would do,” Leahy said.
“A neutron bomb” for Vermont
Many within Vermont’s health care community decried the latest version of the repeal proposal.
“It’s a neutron bomb in a place like Vermont,” said Todd Moore, the CEO of OneCare — the largest health care reform company in the state — and a vice president for the University of Vermont Medical Center. Moore has been working on changing how doctors use insurance money to treat patients.
“We thought we had close to full coverage locked in, and we were going to concentrate primarily on a sustainable cost model,” Moore said. “If the bill passes in Washington, basically everything goes on the back burner while we try and figure out how in the hell we’re going to maintain coverage.”
Before 2014, the state made a deal with the federal government to provide Medicaid-like coverage through a program called the Vermont Health Access Plan and commercial coverage through a program called Catamount Health.
In 2014, when Obamacare went into effect, many people using the Medicaid-like program moved over to Medicaid under the expansion. People using Catamount Health either moved to Medicaid or to commercial plans on Vermont Health Connect. Today, the rate of uninsured people in Vermont is around 3 percent, Moore said.
“I still worry about how many Vermonters are underinsured, meaning they have plans with such high copays and deductibles,” he said. “In Vermont we thought that was going to be one of the problems that we could work on, not basic access to coverage at all.”
Moore said it would be too hard to reinstate programs like that—and even if the state tried to create new health insurance programs with the federal government, health care officials would need to spend all their time doing so. “You can’t just all of a sudden rewind to four years ago,” he said.
Meagan Gallagher, the CEO of Planned Parenthood of Northern New England, said the organization serves 19,000 people in 12 regions of Vermont, and often serves as the primary care provider for women.
“It’s clear that Americans are going to pay more and get less, and women are going to pay the biggest price of all,” she said. “This is without question the worst bill for women in a generation, particularly for low-income women and women of color.”
Gallagher said that Medicaid would only stop reimbursing Planned Parenthood for one year because of the special process Republicans in Congress are using to get the bill through. She said that means the cuts could be approved again in future years.
“If it passes we would be very concerned about it passing again, because a year from now we don’t anticipate that the landscape in Washington will look all that different,” Gallagher said.
Seeking to fix the ACA
Earlier in the week, as Obamacare repeal faced an uncertain future in the Senate, Rep. Peter Welch, D-Vt., made a bid for attempting to fix the current law.
“We’ve got to defend the health care bill,” Welch said. Congressional Republicans, he said, are trying to make policy changes that “would be catastrophic and cruel.”
Welch and nine other House Democrats proposed a five-part plan Wednesday for improving the market where individuals buy health insurance.
He characterized the proposals as an attempt to correct the flaws in the current law at a time when both political parties are firmly entrenched. While Republicans do not want to acknowledge anything good in the Affordable Care Act, Democrats are reluctant to admit anything is wrong with it, he said.
Welch said he believes there could be some appetite for the proposals, “as long as people understand that an acknowledgment of the need for improvement is not a renunciation of progress being made.”
The prospects for the proposals to move forward are unclear. The ideas were put forward by Democrats independently from House minority leadership, though Minority Leader Rep. Nancy Pelosi, D-Calif., called the proposals “promising” and called on Republicans to come to the negotiating table with Democrats.
(Erin Mansfield reported from Montpelier.)