GOP healthcare bill heads to Senate where fate far from certain

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The News:

The US House of Representatives on Thursday (May 4, 2017) voted 217 to 213 in favor of proposed legislation that would repeal and replace parts of the Affordable Care Act (ACA), signed into law by former President Barack Obama in 2010. It is far from clear whether the measure will be passed in its current form in the Senate, where the bill now awaits action.

The American Health Care Act passed the US House of Representatives 217 to 213 Click To Tweet

In March, Republican lawmakers in the House withdrew a measure aimed at overhauling the ACA. Republicans have since redrafted the bill to allow state governments to roll back required coverage for essential services, such as maternity and emergency care.

Additionally, states could seek waivers that would let insurers charge higher premiums for customers with pre-existing medical conditions. Insurers would also be given more freedom, with state approval, to sell less-comprehensive health plans and to raise their prices, says FirstWord Pharma.

The bill, known as the American Health Care Act (AHCA), would also repeal many of the taxes that the current law imposes on drug companies, insurers and high-income people, among others. The proposed legislation would reduce funding for Medicaid, and end the health program’s status as an open-ended entitlement. States would either receive an allotment of federal money for each beneficiary, or they could receive the money in a lump sum, with fewer federal strings.

Meanwhile, the bill would eliminate tax penalties for people who forgo health insurance, and also proposes annual tax credits of $2,000 to $4,000 to replace government-subsidized insurance policies that are offered exclusively on the ACA’s marketplaces. The credits would be reduced for individuals making over $75,000 a year and for families making over $150,000.

According to the Congressional Budget Office, the first version of the bill would have trimmed the federal budget deficit considerably, but would also have left 24 million more people in the US without health insurance coverage after a decade. The latest vote occurred before the CBO released a new analysis of the revised bill with its cost and impact. The Senate, however, will have the benefit of the CBO’s score, due as soon as this week.

Steve’s Take:

As House Republicans cheered the “beginning of the end” of the Affordable Care Act at a celebration in the White House Rose Garden on Thursday, Senate Republicans greeted the bill with a distinctively subdued response.

After weeks of intermittent, spasmodic activity, House Republicans had narrowly passed a proposal to repeal and replace Obamacare and voted to forward to the Senate a bill that is both unpopular with the American public and highly unlikely to pass the chamber in its present form.

The Senate majority leader, Mitch McConnell, hailed the vote as “an important step” and a “job well done.” But Republicans in the upper chamber swiftly vowed to draft their own healthcare legislation rather than take up the House-passed American Health Care Act.

“We are going to draft a Senate bill,” Iowa senator Chuck Grassley told reporters on Capitol Hill, according to The Guardian. “That is what I’ve been told.”

Bill Cassidy, a senator from Louisiana who has been pushing his own Obamacare replacement plan, echoed the sentiment. “I was given the impression it would be a blank sheet of paper,” he said, while adding of the House-passed legislation: “I’m not sure this is the last bill.”

The widespread wariness among Republicans in the Senate was reflective of both the obstacles and limitations they foresee ahead. Republicans hold just 52 seats in the upper chamber and thus can afford to lose no more than three votes.

And so while House Republicans savored the moment, doing what looked like a Conga Line over to the White House, their counterparts in the Senate warned of a long and winding road that could last months before an actual ballot.

“I can’t imagine less than six weeks of a process for us,” said Oklahoma senator James Lankford, while adding of the House-passed bill: “It’s a skeleton, but it’s definitely not the final product.”

“I’m not so sure this is good civics here–a bill [that has] not been scored, not been amended–but it is what it is,” said Senator Lindsey Graham of South Carolina. Citing concerns with preexisting conditions and changes to Medicaid, Graham said the final drafting “will be done by the Senate.” He added, “The Senate is the place still, in my view, where you deliberate, you have a say, you vote.”

Senate Republican leaders signaled they would pursue a process known as budget reconciliation, which would enable them to pass a healthcare bill with a simple 51-majority vote. But Republicans acknowledged they were bound by rules within that process, which limit its scope to spending, taxes or the deficit.

“Anything that makes it impossible to do under reconciliation, we’ll have to either try to do it a different way or at a later time,” said Senator Roy Blunt, a member of Republican leadership.

Republican leaders said a 12-member working group would now take the reins to come up with a draft and build consensus.

After Republicans failed to win enough support to bring their healthcare plan to the floor for a vote in March, moderates led by New Jersey congressman Tom MacArthur and the conservative Freedom Caucus collaborated on a compromise. An amendment drafted by MacArthur would allow states to waive rules that protect individuals with preexisting conditions from being charged more for healthcare coverage.

The provision is a likely a nonstarter in the Senate, where Republicans have already voiced concerns over maintaining coverage for preexisting conditions, among other issues. At least two Republican senators, Susan Collins of Maine and Lisa Murkowski of Alaska, have also opposed attempts to defund Planned Parenthood as part of the healthcare debate.

As Trump claimed victory, flanked by smiling, clapping House Republicans in what resembled a signing ceremony and not simply the opening round, Graham sought to downgrade expectations.

“If you know how this movie ends, you’re better off than I am,” said Graham.

Outside Washington, in a rare display of consensus, essentially the entire medical establishment opposes the bill on moral and financial grounds, notes Bloomberg. The combination of wildly unpopular pre-existing protection cuts, lost insurance coverage, and the specter of gutting Medicaid and subsidies for poor Americans to pay for tax cuts for the wealthy and corporations will make for some difficult 2018 re-election campaigns.

Bottom Line:

The AHCA would cut healthcare spending significantly (mostly for the poor) in order to fund tax cuts (mostly for the wealthy).

If the bill survives at all in the Senate, it will probably be changed considerably. Moderate senators have the upper hand in the Senate and will likely want to soften the portions of the law that will negatively impact hospitals, insurers, and drugmakers. They will likely want the bill to cover more people, to better protect those with pre-existing conditions, and to leave Medicaid mostly intact.

If 50 senators (plus Vice President Mike Pence, who breaks ties) vote for a bill anything like the House bill, it would do great damage to the country, says David Leonhardt for The New York Times. It would harm people who suffer from a wide range of health conditions, including birth defects, cancer, diabetes and just about every other disease–including many people who are perfectly healthy today but could one day fall sick. The bill would also transfer billions of dollars from the poor and the middle class to the wealthy, who are doing just fine, hear tell.

Steve's Take: Call your Congressman to prevent millions from losing their #healthcare Click To Tweet

Those of us centrists who keep scanning the skies for some semblance of truth, equanimity and sensibleness in the political debate offer this plea: Take a moment to assess the forces at work in the Senate. Consider what you can do to prevent millions of your fellow Americans from losing their health care.

Most importantly, remember that making phone calls to your Congressmen or attending events is far more effective than merely posting to Facebook, Twitter, LinkedIn and the many other social media sites.