Centrist Republicans push back on GOP healthcare bill 

Senate Republicans from states that expanded Medicaid enrollment under ObamaCare are pushing back on pressure from Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellMcConnell says he backs Mueller probe after classified briefing Overnight Finance: Trump signs Dodd-Frank rollback | Snubs key Dems at ceremony | Senate confirms banking regulator | Lawmakers lash out on Trump auto tariffs Senate Dems’ campaign chief ‘welcomes’ midterm support from Clintons MORE (R-Ky.) to support the conference’s new healthcare bill.

The centrists want GOP leaders to agree to changes to the bill before they will back their party on a key procedural vote as early as next week.

They specifically want a formula for indexing Medicaid to inflation to be changed so that it is more generous to states getting federal support.

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They also want assurances from McConnell on how an additional $70 billion in money to help lower-income people purchase insurance will be spent.

And they are asking McConnell to put tens of billions of dollars more on the table.

Centrist Republicans pressed their demands during a Thursday meeting in McConnell’s office after the new Senate GOP bill was made public.

Republican Sens. Dean HellerDean Arthur HellerKennedy retirement rumors shift into overdrive McConnell: Midterms will be 'very challenging' for GOP Singer Jason Mraz: Too much political 'combat' in Washington MORE (Nev.), Lisa MurkowskiLisa Ann MurkowskiOvernight Health Care — Sponsored by PCMA — VA reform bill heads to Trump's desk Senators introduce bill to measure progress in opioid fight Dems win nail-biter in charity congressional soccer game MORE (Alaska), Rob PortmanRobert (Rob) Jones PortmanLongtime tax aide leaving Senate Finance Committee Ex-McConnell policy aide joining lobby firm WATCH: Sen. Flake: “More doubtful” North Korean summit will happen  MORE (Ohio), Shelley Moore CapitoShelley Wellons Moore CapitoPa. health secretary: 'Sustainable funding' needed to attack opioid crisis Senate panel unanimously approves water infrastructure bill The Hill's Morning Report — Sponsored by PhRMA — How long can a Trump-DOJ accord survive? MORE (W.Va.) and John HoevenJohn Henry HoevenSenate GOP urges Trump administration to work closely with Congress on NAFTA GOP lawmakers want Trump to stop bashing Congress Chao names participants selected for drone pilot program MORE (N.D.) all attended the meeting.

McConnell is betting that the moderates will come to his side before next week’s vote after he made several concessions to them in the new bill.

The GOP leader can’t afford to lose support from any of them.

Two Republicans, Sens. Rand PaulRandal (Rand) Howard PaulOvernight Energy: Reporters barred from Day 2 of EPA summit | Dems blame Trump for gas price increases | Massachusetts to get new offshore wind farm Senate Democrats look for traction on gas prices GOP Senate primary heats up in Montana MORE (Ky.) and Susan CollinsSusan Margaret CollinsOvernight Health Care — Sponsored by PCMA — VA reform bill heads to Trump's desk Senate panel to consider ban on prescription drug 'gag clauses' Pressure rising on GOP after Trump–DOJ fight’s latest turn MORE (Maine), say they will vote against the procedural motion to begin debate on the bill.

McConnell needs 50 votes, with every Democrat in the Senate prepared to vote no. Vice President Pence would then cast the tie-breaking vote.

He won over Sen. Ted CruzRafael (Ted) Edward CruzPro-Trump super PAC raises .5 million in 6 weeks Trump has exposed Democratic hypocrisy on prison reform Tapper lists 'conspiracy theories' Trump has shared MORE (R-Texas) by including language giving insurance companies more flexibility in what kind of plans they sell, but the concessions risks support from centrists worried that this will lead premiums to rise on sick people and those with pre-existing conditions.

Emerging from McConnell’s office, Hoeven said he is not sure whether the bill has enough money for states. A long-term “innovation” fund designed to help states ensure people can buy insurance has been raised to $132 million.

“We need to see what amount we’d have now with the increase in the long-term fund and then we can determine from there what we need,” he said.

Asked if the $70 billion in additional funding was enough to ease his concerns, Hoeven said, “This is why we need to see the numbers.”

“I’m reserving judgment at this point. I want to see the [Congressional Budget Office] score,” he said.

Moderates have doubts about their leadership’s promises that the innovation fund will be enough to help people likely to lose health coverage after the generous federal subsidy for Medicaid expansion phases out by the end of 2024.

Collins told reporters that leaders appeared to be double- and triple-counting to address various concerns raised by colleagues.

“It seems to me you’re using that money over and over again,” she said, according to Talking Points Memo. “It’s supposed to relieve the cost of high premiums. It’s supposed to solve the problem with deductibles being unaffordable. It’s supposed to be available for high-risk or reinsurance pool. It’s supposed to be available under the Cruz Amendment to help prevent a huge increase in rates for people with pre-existing conditions.”

A GOP aide said other moderates share her concerns.

McConnell has told these centrists that healthcare costs for lower-income Americans will be covered by three pots of money: the funds set aside for tax credits and refundable tax credits, the $132 billion long-term state innovation fund and $45 billion to treat opioid addiction.

“That’s what we talked about,” said Sen. Bill Cassidy (R-La.) of conversations with the leadership.

Cassidy is one of 20 Republican senators from states that expanded Medicaid enrollment under ObamaCare.

He said leaders pledged the stabilization fund would also be enough to cover the higher costs of patients with pre-existing medical conditions.

“States could use the stabilization fund to address the issues of pre-existing conditions that President Trump said he was going to address,” he said.

But while $132 billion may sound like a lot for moderates, several senators who said they remain undecided on how to vote next week worry it might not be enough.

Along with Cassidy, Hoeven, Portman, Capito and Heller said they were undecided on the procedural motion.

Their votes may depend on the analysis from the Congressional Budget Office, which dealt a blow to the Senate legislation last month when it projected that 22 million people would be without health insurance in 2026 because of it.

While the moderates are McConnell’s immediate concern, he has not completely protected his right flank.

Sen. Mike LeeMichael (Mike) Shumway LeeDenial of services to same-sex couples can harm their health GOP Senate primary heats up in Montana Senate GOP urges Trump administration to work closely with Congress on NAFTA MORE (R-Utah), who joined Cruz in recent weeks in demanding insurance regulatory reform, says he remains undecided on the vote to proceed to the bill.

Lee was left out of the deal that Cruz negotiated to allow insurance companies more flexibility to sell plans.

Cruz conceded some ground to colleagues who worried the Cruz–Lee amendment would segment the insurance market and cause the premiums of older, sicker people who buy plans that meet ObamaCare’s regulatory requirements to skyrocket.

He agreed to modify the language by tying the lower-cost risk pools of younger, healthier people who buy cheaper bare-bones plans to the higher-cost risk pools of people who purchase more expensive plans that meet federal requirements.

This is believed to rein in the costs for people with pre-existing conditions.

Leaders have also told moderates that the $132 billion innovation fund can be used to subsidize the cost of high-risk pools as well, but moderates are concerned this will leave less money to cover those likely to lose insurance coverage because Medicaid spending reductions.