Senate Republican leaders released on Thursday a revised plan to dismantle the Obamacare law, but it drew criticism from senators on both sides of the political divide within the Republican party, indicating a treacherous path for the bill.
The bill played to the party’s disparate factions by letting insurers sell cheap, bare-bones policies while retaining taxes on the wealthy.
But the immediate outcry illustrated the difficult political terrain that U.S. Senate Majority Leader Mitch McConnell must navigate. He is under pressure by President Donald Trump to pass a health-care bill and make good on Republicans’ seven-year mission to gut Democratic former President Barack Obama’s signature legislative achievement.
“The American people deserve better than the pain of Obamacare. They deserve better care. And the time to deliver that to them is next week,” McConnell said.
In addition to the criticism from some senators, a major hospital association and one large insurer said the measure falls short in critical areas.
With Democrats united against it, McConnell cannot afford to lose more than two Republican senators to win passage. But moderate Susan Collins and conservative Rand Paul voiced opposition to even bringing the new plan up for debate.
Several senators said they had concerns about the legislation, particularly its Medicaid cuts, including Shelley Moore Capito, Rob Portman, and John McCain. And two other Republican senators, Lindsey Graham and Bill Cassidy, complicated matters by announcing an alternative plan.
McConnell, a skillful tactician who was forced two weeks ago to scrub a planned vote on an earlier version opposed by both moderates and hard-line conservatives in his party, has planned for a vote on the retooled bill next week.
The continuing lack of consensus among Republicans on what to do with Obamacare after calling for its demise since 2010 shows that it is no sure thing that Trump’s party will be able to get the job done.
Health care is Trump’s first major legislative initiative. Failure would call into question his party’s ability to govern despite controlling both chambers of Congress and the White House.
The measure represents a retreat from long-standing Republican aspirations to dump Obamacare-related taxes.
It retains two taxes on the wealthy that helped pay for the Obamacare law that the previous version would have repealed, and also keeps Obamacare’s limits on corporate tax deductions for executive pay in the health insurance industry.
The bill included a provision allowing insurers to offer stripped-down, low-cost health-care plans — a measure proposed by Senator Ted Cruzto try to win over holdout conservatives.
These “skinny plans” would not have to cover the broad benefits mandated under Obamacare like maternity and newborn care, mental health services and addiction treatment, outpatient care, hospitalization, emergency room visits and prescription drugs.
Insurer groups, including the national Blue Cross Blue Shield Association, have derided the skinny plans, saying they would raise insurance premiums, destabilize the individual insurance market and undermine protections for pre-existing medical conditions. Moderate senators could balk at the provision for the same reasons.
The new bill provides an additional $70 billion to help stabilize the individual insurance market on top of the $112 billion in the original bill to help insurers slow growth in premium costs and help lower-income insurance holders cover out-of-pocket medical expenses.
The bill would phase out the Obamacare expansion of the Medicaid government health insurance program for the poor and disabled, and includes sharp cuts to federal Medicaid spending beginning in 2025.
Moderate Republicans were spurned in their desire to see a reduction in Medicaid cuts in the revised version.
Critics said despite some changes to coax wavering senators, the revised bill’s core remains unchanged: restructuring and cutting the critical Medicaid social safety-net program, taking away insurance from millions of Americans and driving up health-care costs for millions of the most vulnerable Americans, especially older people and the sick.
The revamped bill contains a provision that appears to be aimed at winning over Senator Lisa Murkowski of Alaska, a moderate who had opposed the original bill. It would funnel additional money to states that have higher insurance premiums – at least 75 percent above the national average. Alaska is the only state with premiums that high, Senate aides said.