WASHINGTON (CN) – Senate Majority Leader Mitch McConnell released the latest GOP health care bill Thursday, making a bid for conservative support by letting insurers sell low-cost, skimpy policies to consumers while seeking to appease moderates with billions added to combat opioid abuse.
The bill is expected to face a shown vote next week, but as in the case of the original Senate bill, he can only afford to lose two votes.
Right now, both moderates and conservatives are wavering over the revised bill, leaving McConnell with no margin of error as he tries to navigate delivering on a 7-year promise to undo one of the pillars of President Obama’s legacy.
In an effort to assuage the moderates the new bill would extend subsidies to insurance providers to help lower income people, which experts have said are needed to help alleviate market uncertainty, via a 3.8 percent tax imposed on higher income Americans by the Affordable Care Act.
The original Senate bill would have nixed that tax, which makes it particularly unpalatable to Rand Paul of Kentucky, who said Wednesday he would not support the latest version of the bill.
Calling the new bill worse than the first version, he said it falls far short of the GOP promise to fully repeal and replace Obamacare.
To reel in other skeptical conservatives, the new version could incorporate some version of a proposal from Sens. Ted Cruz of Texas and Mike Lee of Utah that will allow insurers to sell paired down plans that eliminate essential health benefits like maternity and mental health care, provided that states offer at least one plan that complies with federal standards.
Citing two GOP aides not authorized to speak about the bill before its release, the AP reported Thursday that the proposal was included in the bill. Lee, however, tweeted that the original proposal had not been added to the bill, known as the Better Care Reconciliation Act.
“Something based on it has, but I have not seen it or agreed to it,” he tweeted. “I am withholding judgment and look forward to reading it,” a second tweet said.
The proposal has drawn sharp criticism from America’s Health Insurance Plans, or AHIP, the health insurance industry’s largest trade group. According to a document on its website, the proposal would destabilize the marketplaces and hit those with preexisting conditions hardest.
“Stable and well-functioning insurance markets require broad-based enrollment and a stable regulatory environment that facilitates fair competition and a level playing field,” the document said. “Unfortunately, this proposal would fracture and segment insurance markets into separate risk pools and create an un-level playing field that would lead to widespread adverse selection and unstable health insurance markets.”
Those with preexisting conditions could lose access to more comprehensive plans, and could face premium spikes, AHIP said.
Moderate Republicans have also objected to the measure for the same reasons, arguing that healthy people would opt for the cheaper plans.
Another problematic provision of the bill would cut federal funding to Planned Parenthood for a year, something Democrats will challenge but most Republicans – especially in the House – would likely balk at if it gets removed.
One Republican Senator, Susan Collins of Maine, has criticized that provision of the bill and stopped just short Wednesday of saying she would not support the current bill.
She has also been critical of the bill’s proposed cuts to Medicaid, which would fundamentally restructure the program by capping payments to states and phasing out the Affordable Care Act’s expansion of the program.
The new package isn’t likely to soothe her concerns, as it would keep most of the first bill’s Medicaid cuts and would nix the tax increases the Affordable Care Act imposes on the health care industry.
The new version would give $45 billion to help states combat the opioid epidemic, and provide extra money to hospitals in states that didn’t expand Medicaid.
Speaker of the House Paul Ryan declined to comment on the bill Thursday during his weekly press conference, saying instead he wanted to give the Senate room to negotiate its new bill. But he signaled the House would stay in session if McConnell can round up the votes to push it through.
“If the Senate is going to give us a health care bill, we’re going to stay and finish health care,” Ryan said.
Sen. Bernie Sanders, I-Vermont, attacked the revised bill on Thursday, calling it “an absolute disaster that will inflict severe economic pain on millions of Americans.”
“Make no mistake about it, thousands of Americans every year will die unnecessarily if this legislation is passed,” Sanders said. “This bill will still throw millions of Americans off of health insurance by cutting Medicaid by nearly $800 billion over the next decade. It will still force older Americans to pay five times as much for health insurance than anyone else. It will still take away health care from 2.5 million women by defunding Planned Parenthood.”
At the same time, Sanders said, ” it will still provide nearly $200 billion in tax breaks to big health insurance companies, drug companies, the medical device industry and tanning salons.”
Sanders said he believes there is no way to “tweak” or otherwise fix the GOP plan.
“It must be defeated,” he said.