By Andrew Siddons and Sandhya Raman, CQ Roll Call
Moderate Republicans on Thursday said they were getting closer to supporting an emerging Senate health package but are continuing to press for a slower phaseout of the Medicaid expansion than the House-passed bill set out.
The Medicaid expansion question seems to remain the biggest unresolved issue as Republicans try to finalize a bill they can vote on before the end of June. To meet their timeline, they would have to send a bill to the Congressional Budget Office for a cost estimate by early next week, according to a Republican aide.
Majority Leader Mitch McConnell has proposed phasing out higher federal payments for people who sign up for Medicaid under the health law’s expansion in three years. Ohio Republican Rob Portman and others such as Nevada's Dean Heller are pushing for a seven-year phaseout ending in 2027. Senators also are debating how much to reduce federal funding for Medicaid as compared to current law.
Portman told reporters Thursday that he was not ready to take a position on the Senate’s health care proposal, but said the fact that there was a plan at all made it easier to negotiate.
“We’re closer because there’s a proposal out there, and this gives everybody the opportunity to weigh in, including me, whereas when it was just a wide-open discussion it was hard to come up with any consensus,” he said.
While he wouldn’t predict the ultimate length of time states would have to phase down the expansion of their Medicaid programs, Portman said he was pushing for a dedicated funding stream to help people struggling with drug addiction.
Medicaid, he said, is “the major payer for the kind of drug treatment that is necessary right now with the opioid crisis and so many people being addicted. The alternative is bad for those individuals and their families but also more expensive for all taxpayers.” He said he had an amount in mind, but wouldn’t specify it.
Heller, another lawmaker from a state that expanded Medicaid who wants a longer phaseout, signaled that the Senate discussions were moving in the right direction. When asked if Senate leaders were receptive to a seven-year phase-out, he said, “They’re listening.”
Heller also said he would oppose lowering the Medicaid growth rate beneath the level set out in the House-passed health care bill (HR 1628).
“I just don’t want to do worse than what the House did. And there’s a push to bring it below the House, so that’s an issue,” Heller said.
Heller, who is up for re-election next year, also said he opposed language in the House bill that could allow states to loosen any protections for those with pre-existing conditions and opt out of providing the “essential health benefits” required by the 2010 law.
Sen. John Hoeven, R- N.D., told reporters that tax credits to help lower-income people pay for insurance were also still up for discussion.
“We’ve got to get a more robust refundable tax credit in place so you make sure that folks have coverage and you also need federal reinsurance for folks with chronic care and pre-existing conditions,” he said.
Hoeven, responding to questions about whether some of the health law’s taxes would remain in place for a longer time than the House bill in order to pay for a more generous package, said it would likely depend on the CBO estimate.
Groups that have pushed for the tax repeal upped their lobbying on Thursday in response to the uncertainty. Scott Whitaker, president of the Advanced Medical Technology Association, which represents the makers of medical devices, urged the Senate to immediately end the medical device tax.
“Will device manufacturers spend hundreds of millions seeking next-generation technologies to improve patient lives? Or will they instead be forced to set those funds aside to pay the job-killing device tax? We need to bank on American innovation and kill this tax,” he said. “Not delay it. End it.”