Republican senators’ revolt puts health bill in jeopardy

A emergency room in Panorama City, California, on 28 January 2009Image copyright
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The legislation affects tens of millions of Americans and nearly a fifth of the US economy

Four Republican senators have expressed reservations about their party’s plan to repeal Obamacare, throwing the health bill’s fate into uncertainty.

Ted Cruz, Ron Johnson, Mike Lee and Rand Paul said they were “not ready to vote for this bill”, but were “open to negotiation”.

The Senate’s Republican leader unveiled his plan to overhaul the US healthcare system after drafting it in secret.

The party can only afford to have two defections to pass the measure.

Republicans need to secure 50 votes when the bill comes to the floor next week. No Democrats are expected to support it.

The statement from the four senators, who are from the more conservative wing of the party, said: “Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor.

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“There are provisions in this draft that represent an improvement to our current healthcare system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their healthcare costs.”

Dozens of people were arrested while protesting the legislation outside the office of Senate Majority Leader Mitch McConnell, who crafted most of the plan.

Two other Republican senators viewed as moderates have also raised red flags with the bill.

Senator Dean Heller – who faces re-election next year – said he had “serious concerns” about the bill’s impact on his home state of Nevada.

He added he would share his reservations with Nevada Governor Brian Sandoval and talk to residents about whether to vote for it.

“As I have consistently stated, if the bill is good for Nevada, I’ll vote for it and if it’s not – I won’t,” he said in a statement on Thursday.

Republican Senator Susan Collins of Maine said it was “too soon” to decide on whether she would vote for the bill.

She expressed “concerns” about the proposed cuts to Medicaid, a government medical programme for low-income Americans, and eliminating funding for the women’s health group Planned Parenthood.

The 142-page “discussion draft” scraps most of President Barack Obama’s 2010 signature health law, including dropping the requirement for individuals to have health insurance and repealing taxes on the wealthy.

Repealing Mr Obama’s law, called the Affordable Care Act but also known as Obamacare, was a central promise of Republicans throughout his presidency.

The Senate leader wrote the upper chamber’s version after their colleagues in the House of Representatives passed Obamacare repeal legislation six weeks ago.

The legislation affects tens of millions of Americans and nearly a fifth of the US economy.

What’s in the Senate bill?

“Republicans believe we have a responsibility to act – and we are,” Mr McConnell said after presenting the Better Care Reconciliation Act Of 2017 to the upper chamber on Thursday.

The bill mostly aligns with a measure passed by the House last month, but ties federal subsidies for individuals based on their income rather than age – as the Affordable Care Act currently does.

It would make it more difficult for recipients to qualify for those subsidies, however, by implementing more restrictions on income requirements.

Critics of the House bill, which tied the subsidies to age, say it unfairly penalised older Americans.

The Senate plan phases out the expansion of Medicaid more gradually than the House bill.

But it would impose deeper long-term cuts to the programme.

The bill also gives states more latitude in requiring insurers to provide essential health benefits guaranteed under Obamacare, including emergency and maternity care and mental health services.

Details of the draft also include:

  • Repealing taxes on the wealthy and insurance companies
  • Continuing payments to health insurance companies to reimburse them for subsidies used to help pay for out-of-pocket costs for low-income Americans for at least two years
  • Stripping funding for US women’s health group Planned Parenthood for a year

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The curtain has finally come up on the Senate healthcare bill, and the product of weeks of back-room negotiations looks a lot like the oft-derided House version.

Sure, there are a few key differences. In some places, it’s more moderate – keeping in place income-adjusted subsidies to help less affluent Americans purchase insurance, for instance.

In other areas the cuts are actually much more aggressive.

It appears Senate Majority Leader Mitch McConnell hopes to mollify moderates and hard-liners by pushing the painful changes to low-income insurance programmes farther down the road.

Whether that’s enough to cobble together the bare-minimum 50 votes necessary from the 52 Republicans in the Senate will be the big question next week.

Moderates and at-risk senators up for re-election last year are the ones to watch – folks like Susan Collins of Maine, Dean Heller of Nevada and Lisa Murkowski of Alaska.

The others may groan, and try to wrangle a few last-minute deals to sweeten the pot, but they face the same reality as their House brethren.

They’ve spent the last seven years saying they’d tear Obamacare up “root and branch”, in Mr McConnell’s words, and they can’t risk walking away empty handed.


What happens next?

Senator McConnell expects the bill to come to the Senate floor as early as next week, when the non-partisan Congressional Budget Office releases the plan’s estimated cost and impact on Americans.

The Republican Senate leadership is hoping to pass the measure, before sending it back to the House for approval of the new draft.

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The House would need to pass the bill as it stands and send it to President Donald Trump’s desk to sign into law or draft another version, which both chambers would again have to approve.

Mr Trump has previously referred to the House version as “mean” and implored senators to draft a more “generous” version.

In a Facebook post, Barack Obama said there was a “fundamental meanness” at the core of the Republican bill.

He described it as “a massive transfer of wealth from middle-class and poor families to the richest people in America”.

Meanwhile, protesters railed against the Senate healthcare bill during a sit-in outside of Mr McConnell’s office on Capitol Hill.

Protesters were heard chanting, “No cuts to Medicaid – save our liberty!”

Republican senators’ revolt puts health bill in jeopardy