Senators’ ObamaCare replacement bills highlight GOP divide

Greg Nash

(This story previously appeared in The Hill Extra) 


As House and Senate Republicans unveiled an aggressive plan to repeal and replace the Affordable Care Act within the next three months, disagreement over two Senate bills introduced this week shows the stark divide within the party over a way forward.

A GOP bill introduced by Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine) seeks the middle ground to replace ObamaCare — but invited harsh opposition from both sides.

Despite a plea for bipartisanship, Democrats have blasted the legislation. 

Sen. Rand Paul (R-Ky.) this week introduced the only other Senate proposal with legislative language — simply called The Obamacare Replacement Act (S. 222) — after calling the Cassidy plan not conservative enough.

Cassidy’s Patient Freedom Act (S. 191) has been praised by some influential senators like Sen. Lindsey Graham (R-S.C.) as a common sense alternative to ObamaCare, and has been gaining momentum with moderate Senate Republicans.  

{mosads}“Once you’ve decided no one’s going to lose coverage, you’re going to take care of pre-existing [conditions], then whether you know it or not you’ve decided on our plan,” Cassidy told The Hill Extra. “Cause I don’t see any way to get there without mandates.”

Conservative alternative.

But conservatives have balked. They can’t tolerate the idea of keeping any parts of ObamaCare, even voluntarily. In particular, the measure keeps many of the law’s taxes that are loathed by conservatives and allows states to keep ObamaCare if they like it. 

After years of railing loudly of the evils of the law, that is a hard pill to swallow.

“As a conservative I don’t think [the Patient Freedom Act] would pass conservative muster,” Rep. Mark Meadows (R-N.C.), chairman of the House Freedom Caucus, told reporters recently. Meadows said he supports the idea of giving healthcare choices to individual states, but not the choice of keeping the ACA.

Paul said his bill is a more conservative alternative and would be able to unify the Republican party. Still, he appears to have no co-sponsors yet.

“We’re open to ideas, but I think the key is it needs to be ideas that all Republicans can vote for,” Paul said. “I think keeping ObamaCare taxes, half the Republicans are not for that, and I think that’s a nonstarter as far as a bill.

“If you like ObamaCare you can keep it in your state, that’s not going to work. People in Kentucky don’t want to pay for ObamaCare for people in New York,” Paul added.

Paul’s legislation would remove many of the ACA’s mandates in an effort to bring the cost of insurance down.

But it also would remove the law’s protections for people with pre-existing conditions. That’s something Trump has said he would like to keep and it’s one of the most popular parts of the law.

The ACA has an outright prohibition on insurers discriminating against such patients. 

Paul’s bill proposes a two-year period where people with pre-existing conditions could get coverage. After that, people with pre-existing conditions would be protected only if they continuously maintained coverage.

Paul said the bill is “grounded in broadly supported conservative reforms that is ready for an immediate vote after ObamaCare is repealed.” 

Middle ground?

The Cassidy-Collins bill contains less drastic changes than some Republican proposals. In addition to keeping many taxes and letting states keep the plan itself, other states could opt into an alternative plan that would provide a uniform tax credit.

“These are two of our most effective United States senators who have thought it through very well, so I think their plan will be seriously considered,” Sen. Lamar Alexander (R-Tenn.), chairman of the Senate’s health committee, said.

While Republicans can repeal Obama’s health law with a simple majority, they’ll need Democrats in the Senate to help pass a replacement bill, and at first glance, the Patient Freedom Act seems like it could accomplish that.

“You can tell we have fashioned this to reach out to the other side. No one can accuse us of being partisan about this,” Cassidy said. But he acknowledged the intraparty disagreements complicate things.

“Let’s be honest. We gotta show that we can keep our act together” before any Democrats could think of supporting the legislation, Cassidy said. “We’ve got a lot of interest on our side, a lot of interest, but at some point, the weight of the caucus has got to be able to settle, and I think it is.”

Dems not on board.

But Democrats have shown no interest in getting on board with the supposedly moderate Patient Freedom Act.

“Millions of Americans would be kicked off their plans, out-of-pocket costs and deductibles for consumers would skyrocket, employer-based coverage for working families would be disrupted, and protections for people with pre-existing conditions, such as cancer, would be gutted,” Senate Minority Leader Charles Schumer (D-N.Y.) said this week.

Rodney Whitlock, a former Republican health policy director on the Senate Finance Committee, told The Hill Extra Republicans “have to engage in a common language” in order to get on the same page. 

“What does coverage look like, and what does cost look like” for both the individual the taxpayer “are the common languages you use,” Whitlock, now vice president for health policy at the consulting firm ML Strategies, said.

“Ultimately, you’re judged based on those numbers. That judgment is not black and white,” and Republicans need to decide what configuration of cost and coverage they’re willing to defend, Whitlock added. 

Yet, Whitlock said it’s to be expected that Republican factions can’t agree on an ACA replacement yet.

“After seven years of not having to take a consequential vote, it’s not concerning” that there’s no consensus on a plan, because it’s only been four weeks, Whitlock said. “No question that there’s a learning curve, but the challenges have always been there.”

If there’s still infighting when legislative text has been scored by the Congressional Budget Office with a cost and official coverage estimates, then Whitlock said he would be worried. 

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