Senator McConnell released the revised Senate repeal-and-replace healthcare bill last week and planned to begin voting on it this week. However, that plan is on hold as Senator McCain recovers from surgery.
The voting process begins with a motion to proceed, which is simply a vote on whether to begin debating and amending a particular bill. If a Senator really doesn’t like a bill, this is the first chance to defeat it. Last month there were not enough votes even among Republicans to take up the first version of this bill, so it went back to the drawing board. No Democrats supported that motion to proceed and none will next week either.
Senators Paul and Collins have said they will not support the motion because the bill is not conservative enough for Senator Paul and too conservative for Senator Collins. That means that the other 50 Republicans must vote for the motion to proceed or the bill will again fail. The usual argument for doing so is “The bill at least deserves the chance to be debated, and if you have problems with it you can offer amendments to change it.” Other Senators appear to be on the fence. They voiced strong criticism of the first draft, primarily because of the reductions in Medicaid spending, and the new draft does not address many of their concerns. The bill goes beyond simply repealing Obamacare by cutting Medicare by $770 billion over ten years compared to spending under current law.
With no margin for error among those 50 Republicans, Senator McCain’s vote is vital so the motion to proceed will wait for his return. It will be interesting to see how the vote goes given the stated concerns of some Senators and the intense pressure from other Republicans and the White House to pass an Obamacare repeal bill of some kind, given the seven years of promises to do so.
The Congressional Budget Office is working on a cost benefit analysis of the revised bill, and its conclusion will affect the debate, especially its Medicaid estimates. The analysis is expected sometime this week.
The primary changes in this bill include:
-The Cruz Amendment, which would allow insurance companies that offer a policy which conforms to the requirements in the Affordable Care Act regarding essential benefits and preexisting conditions to issue a “skinnier” policy that does not offer those benefits. The insurance companies have said this approach will not work because the sick people will all choose the better policy and the healthy people will pick the cheaper skinny policy.
-An increase in funding for opioid abuse treatment from $2 billion to $45 billion. The overall Medicaid reductions of $770 billion over ten years would have the opposite effect on opioid treatment.
-Some of the tax cuts in the original bill for people making over $200,000 per year are being kept in the new version to pay for other changes such as the opioid funding.
-Funds in health savings accounts could be used to pay for insurance premiums.
Based on their public statements, the Republican Senators who seem most undecided or opposed to the revised bill are Senator Heller of Nevada, Senator Capito of West Virginia, Senator Murkowski of Alaska, Senator Portman of Ohio, and Senator Lee of Utah. ACA has formally opposed this bill because of the Medicaid cuts and the lack of a guarantee that mental health benefits would continue to be provided in insurance plans.