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Senate Republicans Close In on Health Bill but Face Revolt Senate Republicans Close In on Health Bill but Face Revolt
(about 1 hour later)
WASHINGTON — Senate Republican leaders on Thursday trimmed their vision of legislation to undo the Affordable Care Act to a skeletal plan that would repeal a few parts of the health law. But they faced a rebellion from Republican senators who demanded assurances that the legislation would never become law. WASHINGTON — Senate Republican leaders on Thursday trimmed their vision of legislation to repeal the Affordable Care Act, unveiling a new, scaled-down bill that would repeal a few parts of the health law in a last-ditch effort to win passage on Friday.
After three days of debate, Republican leaders had little to show for it and were struggling to devise even a stripped-down plan on which at least 50 of the 52 Senate Republicans could agree. The Senate majority leader, Mitch McConnell of Kentucky, was doing whatever he could to secure votes and win Senate approval on Friday for a bill that would repeal at least a few provisions of the Affordable Care Act. After three days of debate, and with little hope of passing more ambitious health legislation, Republican leaders hoped that their bill could win the support of at least 50 of the 52 Senate Republicans.
Passing the bill, though far from what they had hoped to put into law, would at least keep the repeal effort alive, setting the stage for negotiations with the House on what could be a much broader measure to repeal and replace the health law. Several Republican senators castigated the new measure, but that revolt appeared to be quelled after Speaker Paul D. Ryan assured them that he did not intend to take up their narrow bill and pass it in the House.
The new, eight-page Senate bill, called the Health Care Freedom Act, would eliminate penalties for people who go without insurance, but it would not put in place other incentives for people to obtain coverage — a situation that insurers say would leave them with a pool of sicker, costlier customers.
The “skinny repeal” would delay a tax on medical devices. It would also cut off federal funds for Planned Parenthood for one year and increase federal grants to community health centers. And it would increase the limit on contributions to tax-favored health savings accounts.
In addition, the bill would make it much easier for states to waive federal requirements that health insurance plans provide consumers with a minimum set of benefits like maternity care and prescription drugs. It would also eliminate funds provided by the Affordable Care Act for a wide range of prevention and public health programs.
Before rolling out the new legislation, Senate leaders had to deal with a rebellion from Republican senators who demanded assurances that the legislation would never become law.
That raised the spectacle of senators pressed by their leaders to vote on legislation that some of them despise, with a promise that a “yes” would not really be approval, just a vote to start House-Senate negotiations on something better.That raised the spectacle of senators pressed by their leaders to vote on legislation that some of them despise, with a promise that a “yes” would not really be approval, just a vote to start House-Senate negotiations on something better.
Senators Lindsey Graham South Carolina, John McCain of Arizona and Ron Johnson of Wisconsin, all Republicans, simply demanded ironclad assurances from House leaders that the bill would not be enacted. Senators Lindsey Graham South Carolina, John McCain of Arizona and Ron Johnson of Wisconsin, all Republicans, demanded ironclad assurances from House leaders that the bill would not be enacted.
“I’m not going to vote for a bill that is terrible policy and horrible politics just because we have to get something done,” Mr. Graham said, calling the stripped-down bill a “disaster” and a “fraud” as a replacement for the health law. “I’m not going to vote for a bill that is terrible policy and horrible politics just because we have to get something done,” Mr. Graham said at a news conference, calling the stripped-down bill a “disaster” and a “fraud” as a replacement for the health law.
On Thursday night, the House speaker, Paul D. Ryan, tried to reassure senators, as he goaded them to act. “If moving forward requires a conference committee, that is something the House is willing to do,” he said in a statement. “The reality, however, is that repealing and replacing Obamacare still ultimately requires the Senate to produce 51 votes for an actual plan.” On Thursday night, Mr. Ryan tried to reassure senators as he goaded them to act. “If moving forward requires a conference committee, that is something the House is willing to do,” he said in a statement. “The reality, however, is that repealing and replacing Obamacare still ultimately requires the Senate to produce 51 votes for an actual plan.”
But Mr. Ryan did leave open the possibility that if a compromise measure fails in the Senate, the House could still pass the stripped-down Senate health bill. But Mr. Ryan did leave open the possibility that if a compromise measure fails in the Senate, the House could still pass the stripped-down Senate health bill. Late Thursday night, Mr. Graham said that he now felt comfortable and would vote for the measure.
Mr. McCain took advantage of an afternoon news conference to call again for a bipartisan approach to health care. Senator John Cornyn of Texas, the No. 2 Senate Republican, said the scaled-down bill was “a vehicle to get to conference” with the House, which in May passed a more ambitious bill that would repeal much of the 2010 health care law and make deep cuts in projected Medicaid spending.
Mr. Johnson said the bill “doesn’t even come close to honoring our promise of repealing Obamacare” because it would do virtually nothing to address “the challenges, the problems, the damage done” by the Affordable Care Act.
Not even the party leadership in the Senate would promote the merits of the scaled-back bill, which would eliminate the requirement for most Americans to have health insurance but would not replace it with other incentives for people to obtain coverage — a situation that insurers say would leave them with a pool of sicker, costlier customers. This “skinny repeal” would also repeal the mandate that larger employers provide insurance for their employees and could roll back the Affordable Care Act’s tax on medical devices.
It would eliminate funds provided by the Affordable Care Act for a wide range of prevention and public health programs. The money is being used for programs to immunize children, combat smoking and prevent diabetes, heart disease and stroke.
The bill would also cut off federal funds for Planned Parenthood for a year, a decision that could cost crucial votes. “It unfairly singles out Planned Parenthood for elimination of funding under the Medicaid program,” said Senator Susan Collins, Republican of Maine.
Senator John Cornyn of Texas, the No. 2 Senate Republican, said the “skinny repeal” bill was “a vehicle to get to conference” with the House, which in May passed a more ambitious bill that would repeal much of the 2010 health care law and make deep cuts in projected Medicaid spending.
That was an unusual pitch, considering that in normal House-Senate conferences each chamber advocates its version of a bill.That was an unusual pitch, considering that in normal House-Senate conferences each chamber advocates its version of a bill.
“The skinny plan manages to anger everyone — conservatives who know it’s a surrender and know it doesn’t come close to the full repeal they promised, and moderates who know it will be terrible for their constituents,” the Senate Democratic leader, Chuck Schumer of New York, said. He added, “You don’t vote to advance terrible legislation and hope it magically gets better in conference.” “The skinny plan manages to anger everyone — conservatives who know it’s a surrender and know it doesn’t come close to the full repeal they promised, and moderates who know it will be terrible for their constituents,” said the Senate Democratic leader, Chuck Schumer of New York. He added, “You don’t vote to advance terrible legislation and hope it magically gets better in conference.”
Many Republicans seemed to agree. Republicans found themselves in the strange position of hoping their bill would never be approved by the House.
“It may very well be a good vehicle to get us into conference, but you got to make sure that it’s not so good that the House simply passes it rather than going to conference,” said Senator Michael Rounds, Republican of South Dakota. Mr. Rounds, who built a successful insurance business in his home state, said he was concerned that “the markets may collapse” if the Senate bill ever took effect.“It may very well be a good vehicle to get us into conference, but you got to make sure that it’s not so good that the House simply passes it rather than going to conference,” said Senator Michael Rounds, Republican of South Dakota. Mr. Rounds, who built a successful insurance business in his home state, said he was concerned that “the markets may collapse” if the Senate bill ever took effect.
But that does not mean it will not happen. If an assurance came from Mr. Ryan that the bill would be revised in negotiations, Mr. Graham said he would vote for it. Two influential House conservatives made clear that they did not want to simply pass the Senate bill. Representative Mark Walker, Republican of North Carolina and the chairman of the conservative Republican Study Committee, said he favored a conference, calling the bill “ugly to the bone.”
No such assurances from Mr. Ryan were immediately forthcoming, although two influential House conservatives made clear that they did not want to simply pass the Senate bill. Representative Mark Walker, Republican of North Carolina and the chairman of the conservative Republican Study Committee, said he favored a conference, calling the bill “ugly to the bone.” And Representative Mark Meadows, Republican of North Carolina and the chairman of the hard-line Freedom Caucus, said that for many conservatives, it would be a “nonstarter” to send President Trump a bill that has “gotten so skinny that it doesn’t resemble a repeal.”
And Representative Mark Meadows, Republican of North Carolina and the chairman of the hard-line Freedom Caucus, said that for many conservatives, it would be a “nonstarter” to send Mr. Trump a bill that has “gotten so skinny that it doesn’t resemble a repeal.”
But senators had at least some reason to be nervous. The House majority leader, Kevin McCarthy of California, notified House members that “pending Senate action on health care,” the House schedule could change, and that “all members should remain flexible in their travel plans over the next few days.” That did not sound like a man preparing for protracted House-Senate negotiations.But senators had at least some reason to be nervous. The House majority leader, Kevin McCarthy of California, notified House members that “pending Senate action on health care,” the House schedule could change, and that “all members should remain flexible in their travel plans over the next few days.” That did not sound like a man preparing for protracted House-Senate negotiations.
Mr. Ryan offered only, “I’m going to reserve judgment until I see what the Senate actually produces.” The Senate is considering numerous amendments, and “it is anybody’s guess what they come out with,” he said. Mr. Ryan told reporters, “I’m going to reserve judgment until I see what the Senate actually produces.” The Senate is considering numerous amendments, and “it is anybody’s guess what they come out with,” he said.
Representative Chris Collins, Republican of New York and a key ally of President Trump, said the “skinny bill” would be “better than nothing” if it became apparent that the Senate did not have the votes for a more ambitious bill. Representative Chris Collins, Republican of New York and a key ally of Mr. Trump, said the stripped-down bill would be “better than nothing” if it became apparent that the Senate did not have the votes for a more ambitious bill.
“It becomes a binary choice,” he said. “If it’s this or nothing, who wants to go home and say I did nothing?”“It becomes a binary choice,” he said. “If it’s this or nothing, who wants to go home and say I did nothing?”
“No one can guarantee anything,” he added, sending a message to senators wanting assurances.“No one can guarantee anything,” he added, sending a message to senators wanting assurances.
Relatively modest as it is, the Senate bill could have a large impact, especially with the repeal of the individual and employer mandates. Relatively modest as it is, the Senate bill could have a large effect, especially with the repeal of the individual and employer mandates.
“The one thing that unifies our conference is the repeal of the individual mandate and the employer mandate, because those are two of the biggest overreaches of Obamacare and are essential to Obamacare’s functioning,” Senator Cornyn said. “The one thing that unifies our conference is the repeal of the individual mandate and the employer mandate, because those are two of the biggest overreaches of Obamacare and are essential to Obamacare’s functioning,” Mr. Cornyn said.
But without another mechanism to push Americans to maintain insurance coverage, the repeal of those mandates, coupled with the continued Affordable Care Act prohibition on insurers discriminating against customers with pre-existing conditions, could have significant consequences. Healthy people could wait to buy insurance until they are sick. The insurance markets would become dominated by the chronically ill, and premiums would soar, insurers warned.But without another mechanism to push Americans to maintain insurance coverage, the repeal of those mandates, coupled with the continued Affordable Care Act prohibition on insurers discriminating against customers with pre-existing conditions, could have significant consequences. Healthy people could wait to buy insurance until they are sick. The insurance markets would become dominated by the chronically ill, and premiums would soar, insurers warned.
America’s Health Insurance Plans, the Blue Cross Blue Shield Association and the American Medical Association all expressed similar concerns.America’s Health Insurance Plans, the Blue Cross Blue Shield Association and the American Medical Association all expressed similar concerns.
“We would oppose an approach that eliminates the individual coverage requirement, does not offer alternative continuous coverage solutions, and does not include measures to immediately stabilize the individual market,” said America’s Health Insurance Plans, a trade group for the industry.“We would oppose an approach that eliminates the individual coverage requirement, does not offer alternative continuous coverage solutions, and does not include measures to immediately stabilize the individual market,” said America’s Health Insurance Plans, a trade group for the industry.
On the other side, the Trump administration twisted arms. President Trump directed Interior Secretary Ryan Zinke to call Senator Lisa Murkowski of Alaska to remind her of the Alaska issues controlled by the Interior Department, according to people familiar with the call, who requested anonymity because they were not authorized to speak to the press. On the other side, the Trump administration twisted arms. Mr. Trump directed Interior Secretary Ryan Zinke to call Senator Lisa Murkowski of Alaska to “remind her of the Alaska issues controlled by the Interior Department,” according to people familiar with the call, who requested anonymity because they were not authorized to speak to the press.
Ms. Murkowski, one of two Republicans to vote against starting the health care debate, confirmed to reporters that she had received a call from Mr. Zinke, but declined to describe the details. However, people familiar with the call described her reaction to it as “furious.”Ms. Murkowski, one of two Republicans to vote against starting the health care debate, confirmed to reporters that she had received a call from Mr. Zinke, but declined to describe the details. However, people familiar with the call described her reaction to it as “furious.”
Republican senators were briefed on the bill at lunch on Thursday, but the measure remained a work in progress throughout the day.Republican senators were briefed on the bill at lunch on Thursday, but the measure remained a work in progress throughout the day.
“I don’t know whether the end’s going to be fat or skinny or anorexic or bulimic,” said Senator John Kennedy, Republican of Louisiana.“I don’t know whether the end’s going to be fat or skinny or anorexic or bulimic,” said Senator John Kennedy, Republican of Louisiana.
“It’s kind of messy,” he added. “But it’s pretty, in a way, because this is how democracy works.”“It’s kind of messy,” he added. “But it’s pretty, in a way, because this is how democracy works.”