Senate Republicans release new Obamacare repeal bill

By Burgess Everett, Jennifer Haberkorn & Sarah Karlin-Smith
July 13, 2017

Senate Republicans released a new draft of their bill to repeal Obamacare Thursday, which tentatively includes a controversial amendment from Ted Cruz. The change is aimed at building enough GOP support to open debate on the bill next week, but it’s not clear the votes will be there.

Some senators aren’t even sure the bill will get a vote next week given opposition from a cross-section of Republicans.

“I don’t even know that it’s going to get to a vote,” said GOP Sen. John McCain of Arizona.

Senate Majority Leader Mitch McConnell unveiled the plan on Thursday morning at a closed-door, GOP members-only meeting before posting the text online. Unlike their previous bill, which faced stiff resistance across the conference, it would maintain some Obamacare taxes on the wealthy, provide new financial support to help low-income people purchase health insurance, allow people to pay for insurance with pre-tax money and spend billions more to fight opioid addiction.

The amendment from Cruz (R-Texas) could be altered or removed later, sources said. The amendment would allow the sale of cheap, deregulated insurance plans as long as Obamacare-compliant plans are still sold.

It is not yet clear whether the inclusion of Cruz’s proposal will be enough for conservatives. Utah Sen. Mike Lee has previously advocated for the amendment with Cruz, but Cruz has been handling the lion’s share of negotiating with McConnell. Lee is not yet supportive of the latest version because he’s unaware of its content, a spokesman for Lee said.

Cruz said he was encouraged that the updated Senate bill focuses on lowering consumer’s premiums, both through his amendment and the proposal to let people use pre-tax money to pay for their insurance premiums.

“We’re making serious progress towards coming together and unifying our conference and getting a bill that can command the support of at least 50 Senators,” he said on Arizona’s KFYI radio this morning.

Arizona Sen. Jeff Flake threw his support behind the Cruz amendment on the show, but declined to say whether that was enough to get him to vote yes.

Both Cruz and Lee had threatened to vote against starting on the bill if it didn’t have the amendment; more than a half-dozen other Republican senators have stated they don’t support the bill. Any three senators’ opposition would end the GOP’s Obamacare repeal effort on a procedural motion planned for next week, but McConnell is encouraging senators to open debate on the bill and amend it later.

Republicans saw Thursday’s meeting as an airing of all the GOP’s grievances about the latest draft and to help determine whether the party can move forward. McConnell pulled an earlier version of the bill last month amid stiff resistance from conservative and moderate Republicans.

Senators are already angling for more changes. An amendment from GOP Sen. Lindsey Graham would direct much of Obamacare’s federal funding directly to the states that could offer a starting point for Congress if the Senate GOP’s partisan effort fails next week, according to a summary of the bill obtained by POLITICO.

Some Republicans worry that the Cruz proposal could result in split risk pools, one with sick people with pre-existing conditions and the other with healthy young people. Centrists are worried the proposal would undermine protections for people with pre-existing conditions. Cruz and Lee dispute that and will argue it will likely lower premiums and allow people to opt out of Obamacare.

The Cruz amendment would deliver insurance companies subsidies for high-risk Americans with pre-existing conditions under Obamacare’s regulations. If insurance companies offer those plans, they could sell cheap plans that are not subject to those regulations.

Some Republican senators now believe it will be a victory to even open debate on the legislation passed by the House, one senator familiar with the negotiations said.

If that procedural vote is successful, a freewheeling amendment process will begin. At some point, McConnell will introduce a substitute that will represent the Senate’s draft bill. It may be different than what is introduced on Thursday and could be subject to amendment on the Senate floor next week. The bill, in other words, will be a work-in-progress until the final vote.

The Congressional Budget Office is analyzing two versions of the bill, one with the Cruz amendment and one without. The Cruz amendment will be in brackets in the bill released Thursday, indicating it is subject to change.

Senate Majority Whip John Cornyn of Texas declined to say when the CBO score of the Cruz amendment would be released. The analysis for the rest of the draft is expected Monday.

In addition to Cruz and Lee, Sen. Rand Paul (R-Ky.) has cited huge problems with the bill. Paul, who argues the bill keeps too much of Obamacare, has said including the Cruz proposal would not be enough to get his support.

At the other end of the GOP conference, several moderates, including Sens. Susan Collins of Maine and Lisa Murkowski of Alaska are worried that the bill would hurt people with pre-existing conditions and others who got coverage under Obamacare. A number of Republicans are uncomfortable with spending reductions to Medicaid, which covers more than 70 million Americans, including low-income families, people with disabilities and seniors.

Cornyn, who is responsible for gathering the votes for the bill, said there is no other plan that can get 50 votes.

“If you vote “no” on this bill, it essentially is a vote for Obamacare because that’s what we’re going to be left with,” Cornyn said on Fox News Thursday morning. “If Senator Paul can show me 49 other votes for his bill, then I would be all for it. But, unfortunately, the practicality is we have to pass a bill.”

The proposal will also give states new flexibility on their Medicaid funding if a public health emergency — such as a Zika outbreak — takes place. The block grant option would also allow states to add the newly eligible Medicaid population to coverage under the block grant.

The bill also includes $70 billion more than the first draft of the bill’s $112 billion for state-based health care initiatives to drive down premiums. It will include $45 billion for fighting drug addiction and would ease the sale of low-premium “catastrophic” insurance plans.