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 The bill played to the party's disparate factions by letting
insurers sell cheap, bare-bones policies while retaining taxes on
the wealthy.
But the immediate outcry illustrated the difficult political terrain
that U.S. Senate Majority Leader Mitch McConnell must navigate. He
is under pressure by President Donald Trump to pass a healthcare
bill and make good on Republicans' seven-year mission to gut
Democratic former President Barack Obama's signature legislative
achievement.
"The American people deserve better than the pain of Obamacare. They
deserve better care. And the time to deliver that to them is next
week," McConnell said.
In addition to the criticism from some senators, a major hospital
association and one large insurer said the measure falls short in
critical areas.
With Democrats united against it, McConnell cannot afford to lose
more than two Republican senators to win passage. But moderate Susan
Collins and conservative Rand Paul voiced opposition to even
bringing the new plan up for debate.
Several senators said they had concerns about the legislation,
particularly its Medicaid cuts, including Shelley Moore Capito, Rob
Portman and John McCain. And two other Republican senators, Lindsey
Graham and Bill Cassidy, complicated matters by announcing an
alternative plan.
McConnell, a skillful tactician who was forced two weeks ago to
scrub a planned vote on an earlier version opposed by both moderates
and hard-line conservatives in his party, has planned for a vote on
the retooled bill next week.
The continuing lack of consensus among Republicans on what to do
with Obamacare after calling for its demise since 2010 shows that it
is no sure thing that Trump's party will be able to get the job
done.
Healthcare is Trump's first major legislative initiative. Failure
would call into question his party's ability to govern despite
controlling both chambers of Congress and the White House.
"SKINNY PLANS"
The measure represents a retreat from long-standing Republican
aspirations to dump Obamacare-related taxes.
It retains two taxes on the wealthy that helped pay for the
Obamacare law that the previous version would have repealed, and
also keeps Obamacare's limits on corporate tax deductions for
executive pay in the health insurance industry.
The bill included a provision allowing insurers to offer
stripped-down, low-cost healthcare plans - a measure proposed by
Senator Ted Cruz to try to win over holdout conservatives.
These "skinny plans" would not have to cover the broad benefits
mandated under Obamacare like maternity and newborn care, mental
health services and addiction treatment, outpatient care,
hospitalization, emergency room visits and prescription drugs.
Insurer groups, including the national Blue Cross Blue Shield
Association, have derided the skinny plans, saying they would raise
insurance premiums, destabilize the individual insurance market and
undermine protections for pre-existing medical conditions. Moderate
senators could balk at the provision for the same reasons.
The new bill provides an additional $70 billion to help stabilize
the individual insurance market on top of the $112 billion in the
original bill to help insurers slow growth in premium costs and help
lower-income insurance holders cover out-of-pocket medical expenses.
The bill would phase out the Obamacare expansion of the Medicaid
government health insurance program for the poor and disabled, and
includes sharp cuts to federal Medicaid spending beginning in 2025.
Moderate Republicans were spurned in their desire to see a reduction
in Medicaid cuts in the revised version.
Critics said despite some changes to coax wavering senators, the
revised bill's core remains unchanged: restructuring and cutting the
critical Medicaid social safety-net program, taking away insurance
from millions of Americans and driving up healthcare costs for
millions of the most vulnerable Americans, especially older people
and the sick.
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The revamped bill contains a provision that appears to be aimed at
winning over Senator Lisa Murkowski of Alaska, a moderate who had
opposed the original bill. It would funnel additional money to
states that have higher insurance premiums – at least 75 percent
above the national average. Alaska is the only state with premiums
that high, Senate aides said.
"UNACCEPTABLE FLAWS"
Hospital and insurer groups have spoken out against the Senate
Republican approach, particularly proposed Medicaid cuts. The cuts
would result in lower revenues for hospital companies like Community
Health Systems Inc and Medicaid insurance specialists like Molina
Healthcare and Centene Corp.
Molina Healthcare, which has more than 1 million customers on the
Obamacare individual exchanges and manages Medicaid health programs,
said the changes would leave insurers competing for the least risky
customers and would make plans for sick people unaffordable.
The American Hospital Association said the new version of the bill
retained the "unacceptable flaws" of the previous version.
"Instead of merely putting forth an update, we again call on the
Senate to put forth an upgrade," Rick Pollack, president of the
association, said in a statement.
Healthcare stocks were mostly unmoved by the announcement, as Wall
Street analysts described the core of the revised bill as largely
unchanged from the earlier one.
The new bill includes another $45 billion for fighting the opioid
addiction epidemic, on top of the $2 billion in the earlier version.
The nonpartisan Congressional Budget Office, which forecast that the
previous version would have increased the number of Americans
without health insurance by 22 million by 2026, is due to evaluate
the new bill in coming days.
The Affordable Care Act, dubbed Obamacare, expanded health insurance
coverage to some 20 million people, in large part by expanding
Medicaid.
The House of Representatives on May 4 passed its own version of
healthcare legislation.
Republicans have a 52-48 Senate majority, with Vice President Mike
Pence able to cast a potential tie-breaking vote. Any bill passed by
the Senate would have to go back to the House for approval.
Repealing and replacing Obamacare, which Republicans fault as a
costly government intrusion into the healthcare system, was a top
campaign promise for Trump, who was monitoring the Senate
developments during his visit to Paris.
"I'd say the only thing more difficult than peace between Israel and
the Palestinians is healthcare," Trump told reporters on his flight
to Paris.
(Corrects 20th paragraph to show the bill applies to states with
premiums at least 75 percent above the national average, not 75
percent of the national average)
(Additional reporting by Ayesha Rascoe, Yasmeen Abutaleb, Caroline
Humer, Eric Walsh, Lewis Krauskopf and Richard Cowan; Writing by
Will Dunham and Roberta Rampton; Editing by Jonathan Oatis and
Leslie Adler)
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