In a high-stakes bid for conservative support, Senate Majority Leader Mitch McConnell has agreed to demands from Republican Sen. Ted Cruz of Texas to allow insurers to sell low-cost, skimpier plans as part of a new but still-reeling health care bill he was releasing Thursday, GOP aides said.
However, including that provision seems likely to alienate moderates and perhaps other conservatives as the party struggles to unite behind a plan to scuttle much of the Obama health care law. Sen. Mike Lee of Utah, who’d partnered with Cruz, tweeted that the version they crafted wasn’t in the bill, adding, “Something based on it has, but I have not seen it or agreed to it.”
Cruz’s original proposal would let insurers sell plans with minimal coverage, as long as they also sell policies that meet strict coverage requirements set by Obama’s 2010 statute. Moderate Republicans have objected to the idea, arguing that it would make policies excessively costly for people with serious illnesses because healthy people would flock to the cheaper coverage.
The maneuvering by McConnell, R-Ky., came as he unveiled his plan at a closed-door meeting of GOP senators. He was laboring to prevent losing a showdown vote next week on the legislation, a vote in which he has no margin for error. Since Democrats uniformly oppose the effort, McConnell needs the votes of 50 of the 52 GOP senators to prevail, and two already seem certain to vote “no” — conservative Sen. Rand Paul of Kentucky and moderate Sen. Susan Collins of Maine.
McConnell also faces pressure from President Donald Trump, who has warned that he will be “very angry” if the majority leader doesn’t deliver.
According to GOP aides and lobbyists, McConnell’s revamped bill includes what seemed a blow to moderates seeking to protect Medicaid, the federal-state program for the poor, disabled and nursing home patients.
They said the retooled measure retains McConnell’s plan to phase out the extra money that 31 states have used to expand Medicaid under Obama’s statute, and to tightly limit the overall program’s future growth. Since its creation in 1965, the program has provided open-ended federal funds to help states pay the program’s costs.
The rewritten package would add $70 billion to the $112 billion McConnell originally sought that states could use to help insurers curb the growth of premiums and consumers’ other out-of-pocket costs.
It also has $45 billion for states to combat the misuse of drugs like opioids. That’s a big boost from the $2 billion in the initial bill and an addition demanded by Republicans from states in the Midwest and Northeast that have been ravaged by the drugs.
To help pay for the added spending, the measure would retain three tax increases Obama’s law slapped on higher-earning people to help finance his law’s expansion of coverage. Under the current statute, families earning more than $250,000 annually got a 3.8 percent boost on their investment income tax and a 0.9 percent increase in their payroll tax. Obama also imposed a new tax on the salaries of high-paid insurance executives.
The revised bill would also allow people to use money from tax-favored health savings accounts to pay health insurance premiums, another favorite proposal of conservatives.
The details were described by people who spoke on condition of anonymity because they weren’t authorized to describe the legislation publicly before its release.
Many details on the Cruz amendment were not clear. Adding to the uncertainty, the aides and lobbyists said the Cruz provision would appear in the legislative text in brackets, meaning the specific language was still being composed. That could give McConnell, Cruz and other conservatives time to work out a provision with broader support.
In an interview Wednesday with the Christian Broadcasting Network’s “The 700 Club,” President Trump said he will be “very angry” if the Senate fails to pass the health care measure and said McConnell must “pull it off.”
McConnell’s new bill was expected to offer only modest departures from the original version, which he yanked off the Senate floor two weeks ago to avoid certain defeat at the hands of a broad range of unhappy Republicans.
The reworked measure’s key elements remain, easing Obama’s requirements that insurers cover specified services like hospital care and cutting the Medicaid health care program for the poor, disabled and nursing home patients. Obama’s penalties on people who don’t buy coverage would be eliminated and federal health care subsidies would be less generous.
Paul told reporters that the revised measure has nothing “remotely resembling repeal.”
Collins has long complained that the measure will toss millions off coverage. Spokeswoman Annie Clarke said Collins would vote “no” next week “if the Medicaid cuts remain the same” as those that have been discussed.
Besides Paul and Collins, other Republican senators have also been noncommittal on whether they will back McConnell’s bill next week, including Tim Scott of South Carolina and Rob Portman of Ohio.