Policy

Senate Strategy on House Health Care Bill: That’s Not Ours

Republican members sidestep commenting on CBO report

 From left, Sens. John Barrasso, R-Wyo., Roy Blunt, R-Mo., Senate Majority Leader Mitch McConnell, R-Ky., and Majority Whip John Cornyn, R-Texas, arrive for a news conference after the Senate Policy luncheons in the Capitol, March 14, 2017. (Tom Williams/CQ Roll Call)

Senate Republicans have a plan to avoid answering questions on the House legislation to repeal large portions of the 2010 health law: to say it’s not their bill.

The chamber on Friday begins a 10-day recess and lawmakers could face questions from constituents about a recent analysis on the House bill by the nonpartisan Congressional Budget Office. The report, released on Wednesday, said that the legislation would result in 23 million more uninsured individuals over the next decade compared to the current law’s trajectory.

But Senate Republicans are hoping the ongoing effort to write their own bill will calm any concerns they might hear from voters next week.

“That’s the House bill,” said Sen. Marco Rubio, R-Fla. “The Senate bill is going to be the Senate bill. Obviously the CBO score is one data point and it’s instructive, but it’s not our bill.”

More than a dozen GOP members voiced similar sentiments, that the House bill is a distinct product from the proposal senators are currently drafting.

Changing the topic

The sidestep was on full display Thursday morning in Senate Majority Leader Mitch McConnell’s opening remarks. He chose not to address the CBO report and instead blasted Democrats for their refusal thus far to work with Republicans on legislation to fix the health law.

“There’s just no serious way to now try and spin away these years and years of Obamacare failures on cost. By the same token, there’s no serious way to try and spin away or ignore the years and years of Obamacare failures on choice,” the Kentucky Republican said. “Senate Republicans are working together to move past the problems of Obamacare and to help those who have been hurt by it. We would love for Democrats to join us.”

But despite their best efforts, Senate Republicans may very well need to maintain portions of the measure that passed the House earlier this month in order to comply with certain rules governing the fast-track procedure the GOP is using to advance the bill.

“We can’t start entirely from scratch because under the budget rules we have to basically save the same amount of money the House does. But it gives us some ideas about what flexibility we have and we’re working hard on it,” Senate Majority Whip John Cornyn told reporters on Thursday.

The Texas Republican said that he has “never had somebody come up and ask me about a CBO score.”

Congressional Republicans are in a tough spot. There is substantial pressure to repeal the law from the White House and conservative groups, as well as from constituents that have experienced double-digit increases in premium costs. But the measure that passed the House has also elicited significant backlash from Democrats and the health care industry.

“We’ve got a lot of work to do to figure out how to improve a health care system,” Sen. Jerry Moran, R-Kan., told Roll Call. “The current system we have … is insufficient to meet the needs of the American people and the fix to-date is inadequate as well.”

The CBO analysis — which did not come until weeks after the House vote — said the bill would reduce the federal deficit by almost $119 billion over a decade, a finding that House Republicans chose to spotlight in statements following the release of the report.

Troubling findings

But the GOP is facing criticism over several findings in the analysis.

The CBO said the bill could remove the cap on annual and lifetime limits for benefits covered by insurance plans, a popular provision from the 2010 health law. The removal of those caps, the office concluded, could result in a “large increase in out-of-pocket spending” for some enrollees in the individual insurance market.

The bill, CBO said, could also raise costs on some people with pre-existing conditions, a violation of a promise made several times by House Speaker Paul D. Ryan and other GOP leaders.

One of the key reasons for these cost increases is the addition of a last-minute amendment from Reps. Tom MacArthur of New Jersey and Mark Meadows of North Carolina that would allow states to waive out of several of the law’s key insurance requirements.

One of them, the so-called essential health benefits, requires insurers to cover a minimum set of benefits. Removing that requirement, CBO said, could lower the cost of premiums in certain states. Some senators hope to take a similar strategy in their own bill. 

“Obamacare made the price too high by adding mandates to insurance that elevated the price of insurance,” Sen. Rand Paul of Kentucky said. “You want insurance to be free of regulation so it can have less expense.”

But the CBO also said the removal of that requirement could increase out-of-pocket costs for maternity, mental health and substance abuse care by thousands of dollars. That could impact Kentucky, for example, which had the third highest rate of death in the country from opioid overdose in 2015, according to the Center for Disease Control and Prevention. 

Some Republicans, like Senate Health, Education, Labor and Pensions Chairman Lamar Alexander of Tennessee, are advocating a two-step approach for their repeal efforts. The first step would entail stabilizing the shaky insurance markets created by the health law before a major overhaul of the current health care system would occur. The drive behind this, lawmakers say, is to ensure individuals can continue to purchase insurance in the individual market in 2018 and 2019.

Such a strategy, however, faces an uphill battle in the Senate.

“I think we have to do both in one bill,” Cornyn told Roll Call earlier this week.

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