|
 After the Congressional Budget Office (CBO) score, Senator Susan
Collins, a moderate Republican, said she could not support moving
forward on the bill as written.
Collins' opposition highlights the delicate balance that Senate
Majority Leader Mitch McConnell must strike as he tries to deliver a
legislative win to President Donald Trump by reconciling the
Republican Party's moderate and conservative wings.
Moderate senators are concerned about millions of people losing
insurance. Key conservative senators have said the Senate bill does
not do enough to repeal Obamacare.
The CBO assessment that an additional 15 million people would be
uninsured in 2018 under the bill and its prediction that insurance
premiums would skyrocket over the first two years prompted concern
from both sides.
McConnell's goal was to have a vote on the bill before the July 4
recess that starts at the end of this week. But several Republicans,
including Collins, have said they would not approve a procedural
motion that would clear the way for a vote.
McConnell can afford to lose just two Republican senators from their
52-seat majority in the 100-seat Senate, which would allow passage
of the bill with Vice President Mike Pence casting the tie-breaking
vote.
"If you are on the fence ... this CBO score didn't help you, so I
think it's going to be harder to get to 50, not easier,” Republican
Senator Lindsey Graham said of the bill's prospects.
The CBO score is also likely to amplify criticism from industry
groups such as the American Medical Association, which said earlier
on Monday that the Senate's bill violated the doctors' precept of
"first, do no harm."
The CBO is only able to assess the impact of legislation within a
10-year window, but it said that insurance losses are expected to
grow beyond 22 million due to deep cuts to the Medicaid insurance
program for the poor and disabled that are not scheduled to go into
effect until 2025.
Trump and Republicans in Congress made repealing and replacing
Obamacare, former Democratic President Barack Obama's signature
domestic legislation, a central campaign promise. The pressure is on
for them to deliver now that they control the White House, House of
Representatives and Senate.
Republicans view Obamacare as costly government intrusion and say
that individual insurance markets are collapsing. Obamacare expanded
health coverage to some 20 million Americans by expanding Medicaid
and mandating that individuals obtain health insurance.
The CBO score was released just hours after Republicans revised the
bill, adding a measure that would penalize people who let their
insurance coverage lapse for an extended period. The move followed
criticism that the original bill would result in a sicker - and more
expensive - insurance pool.
WHITE HOUSE ROLE
At least four conservative Republicans - Senators Ted Cruz, Rand
Paul, Ron Johnson and Mike Lee - have expressed opposition to the
Senate legislation.
Moderate Republicans have warned against replacing Obamacare with
legislation that is too similar to the version passed by the House,
saying it would cause too many people, especially those with low
incomes, to lose health coverage.
The CBO estimated that the House bill would cause 23 million people
to lose insurance. Trump had called the House bill "mean" and asked
Senate Republicans to come up with "more generous" legislation.
Democrats uniformly oppose both the House and Senate versions of the
bill.
"CBO's report today makes clear that this bill is every bit as 'mean
as the House bill," Senator Chuck Schumer, the Democratic leader,
told reporters.
The White House in a statement on Monday criticized the CBO for
issuing a "flawed report" and said its assessments should not be
"trusted blindly."
Trump and McConnell have been working to shore up support.
[to top of second column] |
The president called key conservative senators over the weekend,
White House spokesman Sean Spicer said.
Both Cruz and Johnson said they were concerned about CBO estimates
that insurance premiums would initially rise as much as 30 percent
over the first two years before declining.
"Doesn't help the people whose premiums skyrocket next year," Cruz
told reporters.
"Kind of a problem, isn't it?" Johnson said of the short-term
premium increase.
Johnson and Paul have said they will oppose the procedural motion
that would allow the Senate to move forward to a vote. Cruz is
drafting suggested fixes. Paul remains opposed to the bill.
The first moderate Republican to oppose the bill, Senator Dean
Heller, is already facing political fallout. America First Policies,
a political group run by former Trump campaign staffers, said it
would air healthcare-related attack ads against Heller, who faces a
competitive re-election race in Nevada next year.
Senator Rob Portman, of Ohio, who has not said whether he supports
the bill, was "dressed down" by McConnell during a Monday leadership
meeting, a senior Republican aide told Reuters.
Ohio participates in Obamacare's Medicaid expansion, and Republican
Governor John Kasich has criticized the Senate bill. Portman's
office did not respond to a request to comment.
Senator Marco Rubio of Florida said his governor, fellow Republican
Rick Scott, would be on Capitol Hill this week to discuss the bill's
impact on the state.
Constituent and industry groups have been critical of the Senate
bill's proposal to reduce the Medicaid healthcare program for the
poor and point to the CBO analysis that it would disproportionately
affect older adults.
LEGISLATIVE TWEAK
Under Senate rules, the bill must replicate savings projected in the
House version that passed last month. It cleared that critical
hurdle, with the CBO estimating it would decrease the budget deficit
by $321 billion over 2017-2026.
A revision to the bill that imposes a penalty for prolonged lapses
in insurance coverage addresses the original bill's provision to
drop the Obamacare penalty on those who do not have insurance.
Experts had warned that canceling the fine could lead to a sicker
insurance pool because young and healthy people would not face
consequences for failing to purchase insurance.
The bill would impose a six-month waiting period for anyone who lets
their health insurance lapse for over 63 days and then wants to
re-enroll in a plan in the individual market.
The 15 million people the CBO estimates would be uninsured in 2018
is largely due to the repeal of the penalty associated with being
uninsured. The CBO did not evaluate the revised version that
included the new waiting period.
Insurer Blue Cross and Blue Shield said it was encouraged by the
inclusion of incentives for continuous coverage. Molina Healthcare
said it preferred the Obamacare mandate, said that and the Senate
bill, even after revised, would simply delay care.
If the Senate passes a bill, it will either have to be approved by
the House, the two chambers would have to reconcile their
differences in a conference committee, or the House could pass a new
version and bounce it back to the Senate.
(Writing by Amanda Becker, Richard Cowan and Frances Kerry;
Additional reporting by Richard Cowan, Eric Walsh and Amanda Becker;
Editing by Leslie Adler)
[© 2017 Thomson Reuters. All rights
reserved.] Copyright 2017 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
