Maine's senior senator says she won't vote for the bill being drafted by her Republican colleagues if it hasn't been analyzed by the non-partisan Congressional Budget Office.
Sen. Susan Collins criticized the secretive process that her Republican colleagues in the Senate are using to craft a replacement to the Affordable Care Act, and said she would not vote for the bill if it hasn’t been analyzed by the Congressional Budget Office.
The American Health Care Act, the ACA replacement bill passed by the House, was approved by lawmakers before it received its CBO score.
In an interview with the Press Herald on Friday, Maine’s senior senator said that the 13 Senate Republicans drafting the bill – an all-male group led by Majority Leader Mitch McConnell of Kentucky – should not be doing so behind closed doors.
Collins said a poor score for the House replacement bill, which the non-partisan CBO estimated would result in 23 million Americans losing health care coverage by 2026, was among the many reasons she voiced her opposition to the bill. She said her goal is for more people in the United States to have health care coverage, not fewer.
“I’m not going to vote for a bill whose impact has not been analyzed by the CBO,” Collins said. “I think that it is not a responsible way to legislate, when you don’t know the impact on cost and coverage. I always believe legislation is best crafted through the normal order. I think it’s much better to have committee consideration of bills, public hearings and to have a full debate. That’s the process for most well-considered legislation.”
When and how Senate Republicans will reveal the contents of their replacement to the ACA is unknown, but recent national news outlets have been reporting that McConnell wants a vote before the July 4 recess or sometime later in July.
Andy Slavitt, a former Obama administration official who headed up the U.S. Centers for Medicare and Medicaid Services, said in a series of tweets Thursday that there are reports that McConnell will release the text of the bill and the CBO score simultaneously, within a few hours of a Senate floor vote.
Other news outlets, including The Washington Post and The New York Times, have reported that Republicans are working at breakneck speed to get a bill in front of the Senate before the opposition has a chance to coalesce.
Collins, however, said she would prefer a much more deliberative process, hearing from experts and those directly affected by the bill, such as hospitals, insurers and state officials.
Collins said she’s been kept in the dark, except for one meeting with the Republican lawmakers, which she described as a “fragmentary outline.”
Collins said it does seem like the Senate bill will be an improvement on the House bill, but that’s not an endorsement of the Senate bill.
“There’s so many questions and unfinished provisions that I by no means can be sure that it would be a bill I would support,” she said. “Having it be better than the House bill is a pretty low bar.”
Collins also reiterated her support for Planned Parenthood, and opposition to de-funding of the agency, which media outlets have reported is part of the Senate bill.
Mitchell Stein, a Cumberland-based health policy consultant, said he was pleased to see that Collins is trying to slow down the process, which he said will help Congress come up with something better, or it could stop a bad bill from becoming law.
“They know how unpopular this is going to be and so they’re rushing it through as quickly as possible,” Stein said. He also said the point of the Senate bill is not to improve health care in the United States, but to provide tax cuts for the wealthy by unwinding the ACA.
Collins is a key vote in a closely divided Senate, where it would take three Republican defections to scuttle a replacement of the ACA. Collins and Sen. Bill Cassidy, R-Louisiana, have introduced a moderate bill to replace the Affordable Care Act, but the bill that seems to get the most attention is the bill being worked on by the McConnell working group.
The ACA has resulted in about 20 million more Americans gaining insurance, through Medicaid expansion and the individual marketplace. The uninsured rate has declined from about 18 percent before the bill went into effect to 11 percent in 2016, according to Gallup polling.
About 80,000 people have ACA insurance in Maine, where the uninsured rate is 9.1 percent. The state has so far not expanded Medicaid – insurance for the low-income and disabled – but a referndum will go before voters in November that if approved would result in Medicaid expansion.
Collins has praised the benefits of Medicaid expansion, especially in states like Indiana that have approved a modified version that requires more cost-sharing by low-income residents. Medicaid is typically free for those who qualify.
But Collins did not close the door on agreeing to some form of a rollback on Medicaid expansion. While the content of the Senate Republicans’ bill remains secret, news has leaked out that it would still end the Medicaid expansion, but rather than do it immediately, would take three to seven years to end the expansion.
“I really want to see the specifics,” Collins said. “There’s a big difference between cutting people off and doing it quickly versus giving states and providers an attempt to come up with a system over seven years.”
Collins said there may be room for compromise on the formula for how Medicaid expansion is funded. For states that expanded Medicaid to those earning up to 138 percent of the federal poverty limit, the federal government is paying 90 percent or more of the cost of expansion. Typically, the federal government pays about two-thirds of the cost, with the states picking up the rest.
“I think there are ways to figure this out. Perhaps it doesn’t drop all the way to what the normal federal match would be,” Collins said.
Collins also is worried about how a replacement bill would affect not just expansion populations, but the entire Medicaid population by changing the underlying formula for how Medicaid is funded. A stingier funding formula could harm rural hospitals and health services.
“That has enormous implications,” Collins said. “We’re not just talking about expanion states or just the expansion population. We’re talking about the entire Medicaid population.”
Collins does believe government can operate Medicaid more efficiently.
“I do think there are reforms in Medicaid that would improve health outcomes and lower costs,” Collins said.
Separate from the Senate bill, Collins also criticized the Trump administration for not being forthcoming about plans for cost-sharing subsidies that help people who earn 250 percent or less of the federal poverty level buy insurance on the ACA’s individual marketplace.
Collins said that by being vague about the subsidies, the administration is causing insurance companies to set their rates higher for 2018 than if the companies knew that the subsidies would continue to be paid at the same rate.
“Another cause of instability in the marketplace is the fact that the administration has been sending very conflicting signals on the cost-sharing reductions,” Collins said.
Senate Majority Leader Mitch McConnell once had passionate views about how carefully Congress should consider sweeping changes to the health care system.
“Fast-tracking a major legislative overhaul such as health care reform or a new national energy tax without the benefit of a full and transparent debate does a disservice to the American people, ”McConnell (R-Ky.) said in 2009, referring to the two big issues of the moment. Democrats using such means, he added, “would make it absolutely clear they intend to carry out their plans on a purely partisan basis.”
Republican hypocrisy is now so rampant that it’s typically ignored or granted the political class’ all-purpose form of absolution: “Everybody does it.”
But everybody doesn’t do it. McConnell is trying to eviscerate the Affordable Care Act using methods at odds with how the law was originally brought to life seven years ago. Obamacare was debated for more than a year and went through an elaborate hearing and amendment process, including some changes urged by Republicans.
By contrast, the bill Senate Republicans are writing is being held as close as the nuclear codes. In the meantime, President Donald Trump and his administration keep providing McConnell excellent cover as their assorted outrages dominate the news and deflect attention from Capitol Hill. The wrecking squad works in the shadows knowing that if the public were given time to absorb the damage in store for millions of Americans, the pushback would be enormous.
Cleverly, Senate Republicans say their coverage-destruction bill will be better than the one Speaker Paul Ryan pushed through the House. Well, great, and a Category 4 hurricane is a bit less harrowing than a Category 5. Most of us would prefer to avoid both.
One of the so-called improvements has leaked out: People would be thrown off Medicaid more slowly under McConnellcare than under Ryancare. But they would still be thrown off, and to pay for this reprieve, the Senate would reportedly include additional cuts to Medicaid elsewhere. To finance all their tax cuts for the rich, Republicans would have to gut insurance for a lot of people.
Why all the secrecy? McConnell is trying to keep the pressure off the many Republican senators who have offered pledges of varying degrees of specificity to protect Medicaid and other aspects of the ACA that benefit their constituents.
Since Democrats have 48 votes against dismantling the existing law, any three Republican senators could put a stop to this fantastically anti-democratic process. They could walk into McConnell’s office and say they’ll oppose any bill that is not made public for at least a month of real scrutiny and discussion. Is this too much to ask of legislation that could threaten the health care of countless Americans?
There is work here for activists, politicians and the media. Activists must understand that they have less time to save the ACA than they might think. Democratic senators must take every opportunity to force this issue to the fore. Disruption in the face of this violation of legislative norms is no vice.
As for the media, Jacob Leibenluft, a former Obama administration official, described the problem well: “If you don’t have hearings, and you don’t have big moments for television, you don’t have bandwidth for coverage.” He added, “I hate to think that looking back on this period, we’ll realize that the most regressive piece of social legislation in modern American history was passed, and no one was paying attention.”
We know that the Trump-Russia story will still be there in a month. We cannot say the same about the health insurance millions of Americans count on. By then, it may be on the road to extinction.
Democratic and Republican Governors Urge Senate To Rethink Health Care Bill
Seven governors express concern about Medicaid cuts, ask for help stabilizing insurance markets.
A bipartisan group of governors has a message for Senate leaders about health care reform: Slow your roll.
Republican governors John Kasich of Ohio, Brian Sandoval of Nevada, and Charlie Baker of Massachusetts joined Democratic governors Steve Bullock of Montana, John Bel Edwards of Louisiana, John Hickenlooper of Colorado, and Tom Wolf of Pennsylvania in a letter Friday to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Chuck Schumer (D-N.Y.).
“We have watched with great interest the recent debate and House passage of H.R. 1628, the American Health Care Act,” the letter begins. “While we certainly agree that reforms need to be made to our nation’s health care system, as governors from both sides of the political aisle, we feel that true and lasting reforms are best approached by finding common ground in a bipartisan fashion.”
So far, that’s the direct opposite of how the Republican-led Congress has approached legislating on health care.
The House passed its version of the American Health Care Act on a party-line vote in May that followed weeks of internal GOP wrangling behind the scenes. Lower chamber Republicans approved this bill without waiting for the Congressional Budget Office to analyze its effects. Eventually, the CBO reported the legislation would result in 23 million fewer people with health coverage over the next decade.
The governors emphasize the importance of improving the private health insurance market and Medicaid, and assert the House legislation ― which the Senate is using as the basis for its bill ― fails to do those things.
“Unfortunately, H.R. 1628, as passed by the House, does not meet these challenges. It calls into question coverage for the vulnerable and fails to provide the necessary resources to ensure that no one is left out, while shifting significant costs to the states,” the governors write.
The Senate is copying the House’s tactics as well as its policies. McConnell skipped the entire committee process in favor of assigning a task force to write his chamber’s version of the bill behind closed doors.
Even Republican senators profess they don’t know what will be in the legislation or what it will do, although none has attempted to force McConnell to change his tack. Senate rules require this particular bill to be scored by the Congressional Budget Office before coming to the floor for a vote.
Senate Democrats have offered to negotiate with Republicans on health care, but only if the goal of repealing the Affordable Care Act were set aside in favor of improving existing health care programs.
In their letter, the governors urge the Senate to act to stabilize the health insurance markets for people who don’t get health benefits from their employers, which comprises insurance purchased directly from insurers or via the Affordable Care Act’s exchange marketplaces like HealthCare.gov.
These markets are troubled by lingering problems with the Affordable Care Act itself that are being worsened by the actions and inaction of President Donald Trump and his administration.
“First and foremost, Congress should focus on improving our nation’s private health insurance system,” the governors write.
The governors ― each of whom leads a state that expanded Medicaid to more poor adults using Affordable Care Act funding ― express serious reservations about the congressional GOP health plan.
The House-passed bill would cut Medicaid funding by one-quarter over the next 10 years by ending the expansions and curtailing federal spending on the program overall, which also serves children, pregnant women, people with disabilities and elderly nursing home residents.
“Medicaid provisions included in this [House] bill are particularly problematic,” the governors write.
The governors also offer a broad set of principles they believe should be the foundation of a new health care reform proposal, including stabilizing insurance markets, preserving Medicaid while offering states greater leeway to run their programs, and promoting more affordable private insurance.
Seven governors express concern about Medicaid cuts, ask for help stabilizing insurance markets.
A bipartisan group of governors has a message for Senate leaders about health care reform: Slow your roll.
Republican governors John Kasich of Ohio, Brian Sandoval of Nevada, and Charlie Baker of Massachusetts joined Democratic governors Steve Bullock of Montana, John Bel Edwards of Louisiana, John Hickenlooper of Colorado, and Tom Wolf of Pennsylvania in a letter Friday to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Chuck Schumer (D-N.Y.).
“We have watched with great interest the recent debate and House passage of H.R. 1628, the American Health Care Act,” the letter begins. “While we certainly agree that reforms need to be made to our nation’s health care system, as governors from both sides of the political aisle, we feel that true and lasting reforms are best approached by finding common ground in a bipartisan fashion.”
So far, that’s the direct opposite of how the Republican-led Congress has approached legislating on health care.
The House passed its version of the American Health Care Act on a party-line vote in May that followed weeks of internal GOP wrangling behind the scenes. Lower chamber Republicans approved this bill without waiting for the Congressional Budget Office to analyze its effects. Eventually, the CBO reported the legislation would result in 23 million fewer people with health coverage over the next decade.
The governors emphasize the importance of improving the private health insurance market and Medicaid, and assert the House legislation ― which the Senate is using as the basis for its bill ― fails to do those things.
“Unfortunately, H.R. 1628, as passed by the House, does not meet these challenges. It calls into question coverage for the vulnerable and fails to provide the necessary resources to ensure that no one is left out, while shifting significant costs to the states,” the governors write.
The Senate is copying the House’s tactics as well as its policies. McConnell skipped the entire committee process in favor of assigning a task force to write his chamber’s version of the bill behind closed doors.
Even Republican senators profess they don’t know what will be in the legislation or what it will do, although none has attempted to force McConnell to change his tack. Senate rules require this particular bill to be scored by the Congressional Budget Office before coming to the floor for a vote.
Senate Democrats have offered to negotiate with Republicans on health care, but only if the goal of repealing the Affordable Care Act were set aside in favor of improving existing health care programs.
In their letter, the governors urge the Senate to act to stabilize the health insurance markets for people who don’t get health benefits from their employers, which comprises insurance purchased directly from insurers or via the Affordable Care Act’s exchange marketplaces like HealthCare.gov.
These markets are troubled by lingering problems with the Affordable Care Act itself that are being worsened by the actions and inaction of President Donald Trump and his administration.
“First and foremost, Congress should focus on improving our nation’s private health insurance system,” the governors write.
The governors ― each of whom leads a state that expanded Medicaid to more poor adults using Affordable Care Act funding ― express serious reservations about the congressional GOP health plan.
The House-passed bill would cut Medicaid funding by one-quarter over the next 10 years by ending the expansions and curtailing federal spending on the program overall, which also serves children, pregnant women, people with disabilities and elderly nursing home residents.
“Medicaid provisions included in this [House] bill are particularly problematic,” the governors write.
The governors also offer a broad set of principles they believe should be the foundation of a new health care reform proposal, including stabilizing insurance markets, preserving Medicaid while offering states greater leeway to run their programs, and promoting more affordable private insurance.
Republican governors John Kasich of Ohio, Brian Sandoval of Nevada, and Charlie Baker of Massachusetts joined Democratic governors Steve Bullock of Montana, John Bel Edwards of Louisiana, John Hickenlooper of Colorado, and Tom Wolf of Pennsylvania in a letter Friday to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Chuck Schumer (D-N.Y.).
The Democrats’ vow to “hold the floor all night,” as Sen. Elizabeth Warren (D-Mass.) put it on Facebook, follows efforts by GOP leadership to craft legislation to repeal and replace the Affordable Care Act (aka Obamacare) entirely behind closed doors.
To pull off their protest, the Democrats will stall every possible procedural vote. Although the tactic may not block a vote on the legislation, it will likely bring attention to Republicans’ plans to pass a bill that overhauls the American healthcare system—which makes up one-sixth of the economy—without anyone outside a small group having a chance to read the bill.
The protest is being streamed live on Facebook, and Democratic lawmakers are asking Americans to join their protest under the hashtags #ShowUsTheBill and #HoldTheFloor
WASHINGTON — After weeks of closed-door meetings, Senate Republican leaders Thursday unveiled a health care bill that would largely scrap Obamacare by making deep cuts in Medicaid, ending the mandate that everyone buy insurance, repealing taxes on wealthy Americans and insurance companies, and stripping funding from Planned Parenthood for a year.
However, four conservative Republican senators — Rand Paul of Kentucky, Ted Cruz of Texas, Ron Johnson of Wisconsin and Mike Lee of Utah— said they "are not ready to vote for this bill" because it does not go far enough in repealing Obamacare. Separately, moderate GOP Sen. Dean Heller of Nevada said he has "serious concerns" about the bill's impact on Medicaid patients.
Former presidential candidate and Ohio Governor John Kasich said he has “deep concerns” about the new health care legislation that Senate Republicans made public Thursday, joining other GOP governors who aren’t thrilled about the Obamacare repeal bill.
“I have deep concerns with details in the U.S. Senate’s plan to fix America’s health care system and the resources needed to help our most vulnerable, including those who are dealing with drug addiction, mental illness and chronic health problems and have nowhere else to turn,” he said in a statement Thursday afternoon.
“Sustainable solutions to the many complex problems facing our health care system will never be solved with a one-party approach that’s developed behind closed doors, without public discussion and input,” the statement continued. “I’m encouraging senators to step back and take a good, hard look at this important issue – and to reach across the aisle in working toward solutions. That’s the only way to address the flaws of Obamacare that we can all agree need to be fixed.”
Kasich is part of a bipartisan group of governors who put out a joint statement last week that denounced the House GOP’s Obamacare repeal bill and urged Senate Democrats and Republicans to work together on their own plan.
I don't know if it is grandstanding and in the end they'll come around
Sen. Dean Heller came out in opposition Friday to draft legislation released Thursday that would overhaul the U.S. health insurance system.
“This bill that’s currently in front of the United States Senate is not the answer. It’s simply not the answer. In this form, I will not support it,” the Nevada Republican said at a press conference.
Heller said he would vote against a procedural motion on Tuesday to end debate on the legislation if the bill is not changed.
Heller is facing one of the most difficult re-election campaigns next year of any sitting GOP senator. The Democratic Senatorial Campaign Committee launched a series of ads earlier this year targeting Heller on the Republican effort to repeal and replace the 2010 health care law. On top of that, Nevada Gov. Brian Sandoval, a Republican who joined Heller at the press conference, has expressed concerns over the Medicaid cuts included in the Senate’s draft bill.
Nevada is one of thirty-one states plus the District of Columbia that expanded Medicaid under the 2010 law. That expansion allowed states to cover a larger portion of their population under the entitlement program with enhanced federal funding.
“These are folks that are worth fighting for. These are the people when I talk about the Nevada family who I’m talking about,” Sandoval said. “The current bill as written is something that needs to change.
Heller joins a quartet of four GOP lawmakers in voicing initial issues, though for different reasons, over the draft largely crafted behind closed doors under the guidance of Senate Majority Leader Mitch McConnell of Kentucky. Republican aides and lobbyists expect more senators to also come out publicly with concerns over the proposal.
The Senate health care bill would cut hundreds of billions of dollars from Medicaid, a program that Donald Trump once promised not to touch.
The Better Care Reconciliation Act unveiled on Tuesday would phase out extra money provided to states to expand Medicaid and restructure the program in ways that would reduce spending on it over the long term.
In May of 2015, one month before he launched his campaign for president, Trump told the conservative Daily Signal that he would not touch the Social Security, Medicare or Medicaid programs.
“I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid,” Trump said. “Every other Republican is going to cut, and even if they wouldn’t, they don’t know what to do because they don’t know where the money is. I do.”
Sen. Dean Heller came out in opposition Friday to draft legislation released Thursday that would overhaul the U.S. health insurance system.
“This bill that’s currently in front of the United States Senate is not the answer. It’s simply not the answer. In this form, I will not support it,” the Nevada Republican said at a press conference.
Heller said he would vote against a procedural motion on Tuesday to end debate on the legislation if the bill is not changed.
WASHINGTON — Less than six weeks after he helped revive a flagging House Republican health care bill and push it to passage, President Donald Trump now says the measure is “mean” and is asking GOP senators to make it more generous.
Trump used those words Tuesday at a closed-door White House lunch with 15 Republican senators, congressional sources say. It was a startling slap at legislation that was shepherded by Speaker Paul Ryan, R-Wis., and whose passage the president lobbied for and praised. At a Rose Garden ceremony minutes after the bill’s 217-213 House passage on May 4, Trump called it “a great plan.”
The Senate’s three big lies about health care
To succeed in gutting health coverage for millions of Americans, Senate Republican leaders need to get a series of lies accepted as truth. Journalists and other neutral arbiters must resist the temptation to report these lies as just a point of view. A lie is a lie.
Lie One: Democrats and progressives are unwilling to work with Republicans and conservatives on this issue. “If we went and got the single greatest health-care plan in the history of the world, we would not get one Democrat vote,” President Trump told an Iowa crowd last Wednesday.
In fact, Democrats, including President Barack Obama when he was in office, have said repeatedly that they would like to work with Republicans to improve the Affordable Care Act. Senate Democratic leader Charles E. Schumer’s office put out a list of such offers, including a June 15 letter from Schumer to Senate Majority Leader Mitch McConnell calling for a cross-party meeting to “find a way to make health care more affordable and accessible.”
But Democrats can never be complicit in a wholesale repeal of Obamacare that would take health coverage away from millions of Americans.
This first lie is important because it rationalizes the Republican claim that the bill has to be draconian because it can’t pass without support from the party’s most right-wing legislators. “This is not the best possible bill,” said Sen. Pat Roberts (R-Kan.). “It is the best bill possible under very difficult circumstances.
But those “circumstances” have been created by the GOP itself. A completely different coalition is available, but Republicans don’t want to activate it because they are hellbent on repealing Obamacare. Why?
This brings us to Lie Two: This bill is primarily about improving health care for American families. No, this effort is primarily about cutting taxes. When it comes to health care, the main thing the bill does is take money away from providing it to pay for the tax reductions it contains and for future bonanzas the Republicans have promised.
The tax cuts in this legislation alone would amount to some $700 billion over a decade, according to the Center on Budget and Policy Priorities. About $33 billion of this would go to tax cuts conservatively averaging $7 million every year to each of the 400 highest-income families in the country. What could $33 billion buy? The CBPP reports it would be enough to pay for the expansion of Medicaid in Nevada, West Virginia, Arkansas and Alaska. Talk about income redistribution.
A telltale: One of the main Republican complaints about Obamacare has been that the deductibles and co-pays under ACA policies are too high. But the Republican bill only makes this problem worse.
As the New York Times’ Margot Sanger-Katz wrote: “Many middle-income Americans would be expected to pay a larger share of their income to purchase health insurance that covers a smaller share of their care.”
If this bill were truly about health care, Republicans would take all the tax cuts out and use that money to ease the pain their bill would cause. But they won’t, because the tax cuts are the thing that matters to them.
Lie Three: The Senate bill is a “compromise.” Really? Between whom? The House wants to destroy Obamacare quickly, the Senate a bit more slowly while also cutting Medicaid more steeply over time. This is only a “compromise” between two very right-wing policies.
Imagine you are negotiating with two creditors who say you owe them $1,000 and you insist you owe nothing. The first creditor wants the money quickly. The second says you can take a bit little longer, but you have to pay $1,200 — and he has the nerve to call this a “compromise.” Nowhere in this deal is your position taken into account. Welcome to the logic of the Senate health-care bill.
I hope I never have to write about Lie Four, which would be Republican senators who surely know better — including Susan Collins, Dean Heller, Lisa Murkowski, Jeff Flake, Shelley Moore Capito and Rob Portman — justifying their votes for this monstrosity by claiming that it’s the best they could do.
Heller signaled doubts about the proposal on Friday, which is a step in the right direction. But only by killing this bill would these senators open the way for reasonable fixes to the ACA. Do they really want to say someday that one of their most important votes in the Senate involved taking health care away from millions of Americans? I would like to believe they are too decent for that. I hope I’m not lying to myself.
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