Senate Republicans are making a concerted effort to construct a viable replacement for Obamacare they can unanimously support, but a few disagreements threaten to stall the effort.
1) Funding For Obamacare’s Medicaid Expansion Program
A handful of conservative senators are pushing for steep cuts to Medicaid but face a formidable obstacle from Republican senators in states that participated in the expansion program.
Conservative senators are seeking an immediate roll back of the federal money granted to Medicaid expansion. The senators argue that serious cuts to the program’s funding would force states to make prudent decisions regarding how they choose to spend Medicare funds. At the same time, they fear retribution from constituents if they vote in favor of gutting Medicaid.
Recent estimates out of the Congressional Budget Office (CBO) predict 23 million Americans would lose health insurance if Congress passed the American Health Care Act (AHCA), with a large portion of the loss stemming from Medicaid consumers.
If the Senate passes legislation that guts Medicaid even more than the House proposal, Republican senators in expansion states could face a lot of heat in the 2020 election cycle. Some 20 Republican senators are in states that chose to expand Medicaid under Obamacare, and many are concerned about the number of Medicaid recipients who would lose coverage under the AHCA.
2) Obamacare Subsidies
The White House and Congress asked for a 90-day delay on a court hearing regarding a vital feature of Obamacare — cost-sharing reductions (CSRs) — in late-May.
Under the leadership of former Speaker of the House John Boehner, the House filed suit against the Obama administration in 2014, claiming it was illegally reimbursing marketplace insurers for CSRs.
Obamacare requires insurers to provide CSRs to low and moderate income individuals who participate in the exchanges. To make consumers put more “skin in the game,” Obamacare effectively raised deductibles to levels that are tough for many Americans to meet without some financial support — a consequence of bringing millions of new consumers into the health insurance marketplace. CSRs were instituted to help insurers with the costs of the deductibles patients can’t otherwise meet.
The case was stalled in U.S. District Court of Appeals for the District of Columbia in 2014, after the Obama administration filed an appeal against the court’s ruling that the House’s claim had legal standing.
The Obama administration then appealed the decision. The case remains open, with no definitive ruling. Republicans have now pushed the court date back three times.
As it stands, the administration and congressional leadership have agreed to continue paying out Obamacare subsidies till the case is up for review once again in September. One troubling fact for insurance companies is that some $7 billion is allocated to CSRs this year and another $10 billion is slated for 2018.
If Trump and the Republican leadership don’t fund the program past September 2017, they leave insurers, who are already paying out billions in CSRs, without any chance of reimbursement from the federal government.
Understandably, insurance companies are in a near state of panic trying to figure out whether or not the Trump administration will come through on funding Obamacare subsidies.
“We urge Congress to take action now to guarantee a steady stream of CSR funding through 2018,” America’s Health Insurance Plans (AHIP) wrote in the letter to senators released to The Daily Caller News Foundation. Continuing Obamacare subsidy payments would eliminate the “single most destabilizing factor causing double-digit premium increases in 2018,” the health care groups wrote.
3) The Race For 50 Votes
Senators are trying to pass health care reform through the budget “reconciliation” process, which requires that every provision or amendment have a direct impact on the budget. Typically, a bill needs 60 votes before it can make it out of the Senate. Under the reconciliation process, a bill only needs 50 votes.
Senate Majority Leader Mitch McConnell and Sen. Lindsey Graham of South Carolina are both highly skeptical about the Senate’s ability to pass health care reform.
McConnell is on record in late May saying that he was not sure how to get the 50 votes needed to pass some version of Obamacare repeal in the Senate. The Senate majority leader still said that the “goal” is to get to 50 votes, but he isn’t quite sure how the votes will pan out.
Graham said Monday evening that he thinks it is better to “let Obamacare collapse” rather than trying to continue with this divided repeal effort. “I don’t think we can put it together among ourselves. I’ve always believed let Obamacare collapse,” Graham told reporters.
McConnell is pushing for a vote to happen on July 4, whether or not the legislative body is ready for it. The Senate majority leader wants to send a draft of the bill to the CBO for review as early as Friday.
“We’re going to have a vote one way or the other,” Republican Sen. John Thune of South Dakota told reporters Monday. “But if we don’t pass something, and we go into ’18? It’s on us to try and get this fixed.”
If McConnell is unable to get a version of the Senate bill to the CBO for scoring within a quick timeframe, some warn that a July 4, or earlier, vote will not happen.
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