WASHINGTON — The Senate Republican plan for replacing the Affordable Care Act faces a tricky path to approval when it comes up for a vote, with several GOP senators voicing reservations Thursday that could scuttle the legislation.
But none of the Republicans said the objections were non-negotiable, and Senate leaders hoped to push the bill to a vote before the Fourth of July.
The 142-page bill, unveiled Thursday after weeks of secret negotiations led by Senate Majority Leader Mitch McConnell of Kentucky, would cut deeply into Medicaid. It would eliminate most taxes that funded the expansion of health care insurance under the Affordable Care Act to millions of Americans, including about 5 million in California, and end the mandate that people buy insurance.
Photo: J. Scott Applewhite, AP
The new bill would keep some of the most popular parts of the health care law passed in 2010 and signed by President Barack Obama, including requiring insurance companies to issue policies to people with pre-existing medical conditions and allowing parents to keep their children on their policies up to age 26. But states could allow insurers to charge far more for people with preexisting conditions than they can under the Affordable Care Act.
And many other aspects of the current law would be jettisoned. Like a House health-care bill approved in May, the Senate measure would allow states to opt out of provisions in the Affordable Care Act that require insurers to provide such basic benefits as prescription drugs, emergency care and maternity coverage.
The legislation would also strip funding for Planned Parenthood. The organization provides health care to one in five women and is already banned by law from providing abortions with taxpayer funds, but Republicans object that the organization provides privately paid abortion services.
And the measure would bar insurers that sell policies to people under the federal law from providing abortion coverage, something that California law requires. Anyone wanting such coverage would have to buy a policy out of their own pocket.
“Obamacare isn’t working, by nearly any measure it has failed, and no amount of 11th-hour reality-denying or buck-passing by Democrats is going to change the fact that more Americans are going to get hurt unless we do something,” McConnell said.
However, he quickly ran into opposition not just from unified Democrats, but from several senators in his own party. McConnell can afford just two defections — Republicans hold 52 of the Senate’s 100 seats, and can win a 50-50 vote with a tie-breaker cast by Vice President Mike Pence.
Four of the Senate’s most conservative Republicans — Ted Cruz of Texas, Mike Lee of Utah, Rand Paul of Kentucky and Ron Johnson of Wisconsin — said they would oppose the plan as written because it did not repeal the entire Affordable Care Act. But Paul, for one, said he is open to negotiation.
A more moderate Republican, Sen. Susan Collins of Maine, said she fears that thousands of her constituents would be stripped of their coverage. She also said she would offer an amendment to strip the Planned Parenthood defunding. “It’s just wrong,” she said.
However, Collins did not say how she would ultimately vote.
The nonpartisan Congressional Budget Office is expected to release an assessment early next week of how the Senate legislation will affect the public. The office concluded that the House version of the bill would lead to 14 million people losing or deciding to drop their health insurance within the next year and 23 million by 2026.
California’s two Democratic senators slammed the new bill, saying its main beneficiaries were wealthy people who would enjoy a tax cut, thanks to the GOP plan to eliminate tax hikes that fund the Affordable Care Act.
Sen. Kamala Harris denounced the plan “to give tax benefits to the richest among us, allowing what will end up being among the poorest among us to face serious and severe consequences, including — and I don’t want to sound too extreme here — but including death.”
Sen. Dianne Feinstein said most of the complaints about the Affordable Care Act come from people who abruptly lose federal subsidies for purchasing insurance when they exceed income limits. “We ought to fix things like the individual market, and that’s fixable,” Feinstein said. “But to throw everything out?
“There isn’t any one of the very wealthy people that would be impacted by this who will say, ‘I need a tax cut,’” at the expense of depriving people of health care, she said. “It’s bizarre thinking.”
The Senate measure would largely maintain the structure for federal subsidies now used by people to buy insurance on health care exchanges, including the one in California called Covered California. But it could reduce the number of people eligible to receive those subsidies by changing the income requirement from 400 percent of the federal poverty line (about $55,000 a year for an individual) to 350 percent (about $49,000 a year).
Although the Senate bill would keep the popular Affordable Care Act requirement that insurers make policies available to people with preexisting conditions, Harris noted that companies would be allowed to charge far more for such policies than they can now. The bill would “not deny coverage, but it would just make it much more expensive, prohibitively,” she said.
The biggest target, however, is Medicaid, which provides coverage for the poor and millions of working-class Americans in states such as California that expanded the program with federal help. Medicaid, which is known as Medi-Cal in California, also pays for nearly two-thirds of Americans in nursing homes, almost half of all births, and care for 60 percent of disabled children.
The Affordable Care Act greatly expanded funding for Medicaid to allow low-income people who had been unable to afford insurance to purchase policies. Both the Senate and House bills would phase out that expansion. The Senate version would do so more slowly, but would eventually make deeper cuts to the program than would the House version. It would do that by tying how much money states get to the overall inflation rate instead of the rate of medical inflation, which is significantly higher.
The Senate bill would help poor people more than the House measure would in at least one respect: It would give tax credits to people to purchase policies and would base them on income. The House bill would base the credit on consumers’ age, meaning a wealthy 60-year-old would get as big a break as a poor one.
President Trump hailed the House measure as a major victory after it passed in May and hosted the GOP House delegation in a Rose Garden celebration. But he seemingly turned on the bill earlier this month, calling it “mean” and urging the Senate to come up with something that had more “heart.”
“It’s going to be very good,” Trump said Thursday of the Senate bill. But White House spokeswoman Sarah Huckabee Sanders declined to say whether the president would formally endorse it. She said Trump “wants to bring all the stakeholders to the table, have those conversations, and we’ll get back to you.”
Republicans have argued that the current law is not working, and Democrats have agreed that it needs repairs. But uncertainty surrounding the law’s repeal and moves by the administration to weaken the act have destabilized the individual insurance market markedly in recent weeks. Facing decisions on whether to participate in the exchanges next year, several major insurers have pulled out, leaving millions of individuals stranded.
Many Republican senators, while invited to offer suggestions, were kept in the dark about the contents of the legislation until it was made public Thursday. Democrats denounced the secret process, which included no public hearings on a bill that will affect most Americans and a sixth of the economy.
If the bill clears the Senate, Republicans will attempt to reconcile it with the House-passed bill to produce a single version, and then present it again for approval in both chambers. The bill only narrowly passed the House with the help of every California Republican, including seven who represent districts won by Democratic presidential nominee Hillary Clinton in November. Many stayed on the fence until the last minute.
No Democrat in either house is expected to support the effort. The legislation also faces intense opposition from doctors and hospitals, patient groups such as the American Diabetes Association and American Cancer Society, as well as the powerful AARP. Many of these organizations have already begun advertising campaigns against the bill.