Senate health-care bill faces serious resistance from GOP moderates – Washington Post

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A small group of moderate Republican senators, worried that their leaders’ health-care bill could damage the nation’s social safety net, may pose at least as significant an obstacle to the measure’s passage as their colleagues on the right.

The vast changes the legislation would make to Medicaid, the country’s broadest source of public health insurance, would represent the largest single step the government has ever taken toward conservatives’ long-held goal of reining in federal spending on health-care entitlement programs in favor of a free-market system.

That dramatic shift and the bill’s bold redistribution of wealth — the billions of dollars taken from coverage for the poor would help fund tax cuts for the wealthy — is creating substantial anxiety for several Republican moderates whose states have especially benefited from the expansion of Medicaid that the Affordable Care Act has allowed since 2014.

Their concerns that the legislation would harm the nation’s most vulnerable and cause many Americans to become uninsured have thrust into stark relief the ideological fault lines within the GOP. Though Senate conservatives were the first to threaten to torpedo the bill, contending that it is too generous, the potential loss of nearly half a dozen moderate lawmakers’ votes may be the main hurdle. Since the bill will get no support from Democrats, Senate Majority Leader Mitch McConnell can afford defections from no more than two Republicans as he tries to bring it to a vote this week.

His odds worsened Friday when Sen. Dean Heller (R-Nev.), who is up for reelection next year, said he could not support the bill in its current form. Heller specifically cited its cuts to Medicaid, not just by ending its expansion in Nevada and 30 other states but by restricting government spending for the program starting in 2025.

(Peter Stevenson/The Washington Post)

This bill “is simply not the answer,” he declared, describing some of the 200,000 Nevadans who have gained health coverage through the expansion. He rhetorically asked whether the Republican plan will ensure that they have insurance in the future. “I’m telling you, right now it doesn’t do that,” he said.

Though three of the other four wavering GOP centrists also come from Medicaid-expansion states, not all were as explicit as Heller in their reactions after the Better Care Reconciliation Act was finally unveiled late last week. Both Sens. Shelley Moore Capito (W.Va.) and Lisa Murkowski (Alaska) said that they would evaluate it with an eye toward its effect on low-income residents.

“It needs to be done right,” Murkowski said in a tweet. “I remain committed to ensuring that all Alaskans have access to affordable, quality health care.”

Part of the pressure the moderates now face is that Medicaid consistently draws widespread support in surveys. A poll released Friday by the Kaiser Family Foundation found that three-fourths of the public, including 6 in 10 Republicans, said they have a positive view of the program. Just a third of those polled said they supported the idea of reducing federal funding for the expansion or limiting how much money a state receives for all beneficiaries.

Even among Republicans, the foundation found, only about half favor reversing the federal money for Medicaid expansion.

Congressional budget analysts plan to issue their projections as early as Monday on the legislation’s impact on the federal deficit and the number of Americans with insurance coverage. Already, proponents and critics alike are predicting that the Senate proposal would lead to greater reductions through the Medicaid changes than the estimated $834 billion estimated for a similar bill passed by House Republicans last month.

“The focus of Republican efforts largely has been on costs,” said Lanhee Chen, a research fellow at Stanford University’s Hoover Institution. “You do have a different set of issues that the two sides have been focused on, which partly explains why this has been such an intractable and difficult debate to find common ground on.”

See where the Senate health-care bill’s subsidy cuts will affect Americans most

Under the Senate GOP version, 2021 is when Medicaid’s transformation would begin. The expansion, which has provided coverage to roughly 11 million people, would be phased out. What is now an open-ended entitlement, with federal funding available for a specific share of whatever each state spends, would be converted to per capita payments or block grants.

Then, four years later, the federal government would apply an inflation factor to spending increases that would be equal to the urban consumer price index rather than the higher medical inflation rate used in the House bill.

“There has never been a rollback of basic services to Americans like this ever in U.S. history,” said Bruce Siegel, president of America’s Essential Hospitals, a coalition of about 300 hospitals that treat a large share of low-income patients. “Let’s not mince words. This bill will close hospitals. It will hammer rural hospitals, it will close nursing homes. It will lead to disabled children not getting services. . . . People will die.”

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