Senate Republicans Homing in on Final Health Bill

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By Colleen Murphy and Alex Ruoff

A health bill in the Senate is still far from final, despite some Republicans saying they plan to pass it before the Fourth of July.

None of what Senate leaders have proposed thus far marks stark changes from the House-passed measure that would repeal and replace the Affordable Care Act, despite criticism from Senate Republicans. Voting on the bill—even if it fails—as soon as possible may be critical for giving lawmakers the bandwidth needed to tackle other thorny issues, such as tax reform and a fiscal year 2018 budget.

“We are making progress—how significant that is, how far down, I don’t know,” Sen. Ron Johnson (R-Wis.) said June 6. “This is a really big mess in a very complex system, so you don’t do that in a couple of weeks.”

Republicans are still working through the details on more contentious elements of the measure, like the Medicaid funding. Their plan to adjust the bill’s refundable tax credits hasn’t changed since it was considered in the House: amp up the credits for low-income and older individuals, and perhaps include an adjustment based on geography.

Republican leadership is pressing to limit the House-passed bill’s provision allowing states to waive some of the ACA’s protections for people with pre-existing conditions, lawmakers said. Senators don’t want states to be able to lift the health law’s requirements that bar insurers from charging people for care based on their health conditions.

‘Near Future’

While Senate Majority Leader Mitch McConnell (R-Ky.) wouldn’t nail down timing for a floor vote, he said June 6 that members were getting close to being able to whip up votes for the bill and plan to move forward in the “near future.”

Senators are currently working with the Congressional Budget Office on various components of the bill, including the size of the tax credits, said Sen. John Thune (R-S.D.), a Finance Committee member. The CBO must issue a score on the bill, detailing how much it would cost and how many individuals would lose coverage, before the chamber can hold a vote. The latest score on the House bill found that 23 million people would eventually lose coverage.

“Right now it’s really a scoring thing, trying to figure out what we can fit into the score we have to work with,” Thune said.

Mulling Medicaid

Senate Republicans increasingly favor providing support to states that expanded their Medicaid programs under the ACA beyond 2020, which is the cutoff point for this funding in the House-passed version.

GOP leadership proposed extending the federal funds for the 31 states and the District of Columbia that expanded their Medicaid program under the ACA at least two years longer than the House-passed version, Sen. Tim Scott (R-S.C.) told reporters.

The additional years of funding would taper off, giving states less funding each year as they wind down their programs, Sen. Bill Cassidy (R-La.) told reporters June 6.

However, it’s unclear how Republicans would pay for extending the Medicaid funding, which would cost billions.

In addition, a Senate bill would likely alter the House bill’s controversial provision allowing states to waive parts of the ACA. The House version allows states to waive the health law’s pricing and plan design requirements for health insurers, which would undercut the ACA’s protections for people with pre-existing conditions.

Senate leadership’s proposal would allow states to waive the health law’s plan design requirements, known as essential health benefits, but not its pricing rules, according to a Republican staffer. The bill would also include extra funds for the state stabilization fund to help support state-sponsored reinsurance programs and high-risk pools.

Cassidy said the changes would protect people with health conditions from skyrocketing insurance premiums.

The Senate proposal is “very cognizant of pre-existing conditions, which is a good thing,” he said.

Tax Credit Considerations

McConnell declined to comment on how he wants the House bill’s tax credits to be changed. Vice President Mike Pence met with senators for lunch June 6, but McConnell said the meeting wasn’t pivotal.

Even before the House eked out a bill May 4, Senate Republicans hammered the House bill for proposing tax credits that are too small for individuals older than 50 and low-income individuals.

An amendment to the House health bill set aside $85 billion for the Senate to rework the bill’s refundable tax credits. But “doling out some tax credits here and tax credits there” won’t save the bill, Finance Committee ranking member Ron Wyden (D-Ore.) said during a June 6 news conference.

Middle- and low-income taxpayers would get nothing from the Senate’s version of the House health care bill, while the wealthy would get a “giant, big wet kiss,” Sen. Chris Murphy (D-Conn.) said during the news conference. The House bill comes with $663 billion in tax changes that benefit corporations and the wealthy, and $276 billion in cuts to tax credits for the middle class, Democrats said.

The existence of the tax credits is a deal breaker for Sen. Rand Paul (R-Ky.), according to Sen. Lindsey Graham (R-S.C.). While Paul didn’t comment June 6, he previously panned the House bill for creating a new entitlement program. Senate Republicans can afford to lose two votes and still pass the bill.

A spokesman for Paul said the senator hopes the bill “can be improved in the days ahead and is keeping an open mind.”

“While we do have a press assistant opening in the Communications Department, Senator Graham has not applied and should not make public statements on behalf of Senator Rand Paul,” the spokesman said in an email to Bloomberg BNA.

To contact the reporters on this story: Colleen Murphy in Washington at cmurphy@bna.com; Alex Ruoff in Washington at aruoff@bna.com

To contact the editor responsible for this story: Meg Shreve at mshreve@bna.com

Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.

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