Lamar Alexander responds to Senate bill
"To begin with, the draft Senate health care bill makes no change in the law protecting people with pre-existing conditions, no change in Medicare benefits, and increases Medicaid funding- that's TennCare-at the rate of inflation. Let me repeat: it makes no change in the law protecting people with pre-existing conditions, no change in Medicare benefits, and increases funding for Medicaid-that's TennCare-at the rate of inflation."
UPDATE:
WASHINGTON - Senate Republicans released their long-awaited bill Thursday to dismantle much of Barack Obama's health care law, proposing to cut Medicaid and erase tax boosts that helped Obama finance his expansion of coverage. The measure encountered immediate trouble as four GOP senators said they opposed it but were open to negotiations.
The bill would provide less-generous tax credits to help people buy insurance and let states get waivers to ignore some coverage standards that "Obamacare" requires of insurers. And it would end the tax penalties under Obama's law on people who don't buy insurance - the so-called individual mandate - and on larger companies that don't offer coverage to their employees.
The measure represents the Senate GOP's effort to achieve a top tier priority for President Donald Trump and virtually all Republican members of Congress. Senate Majority Leader Mitch McConnell, R-Ky., hopes to push it through his chamber next week, but solid Democratic opposition - and complaints from at least a half-dozen Republicans - have left its fate unclear.
"We have to act," McConnell said on the Senate floor. "Because Obamacare is a direct attack on the middle class, and American families deserve better than its failing status quo."
But some Republican senators, as well as all the Senate's Democrats, have complained about McConnell's proposal, the secrecy with which he drafted it and the speed with which he'd like to whisk it to passage. McConnell has only a thin margin of error: The bill would fail if just three of the Senate's 52 GOP senators oppose it.
Democrats gathered on the Senate floor and defended Obama's 2010 overhaul. They said GOP characterizations of the law as failing are wrong and said the Republican plan would boot millions off coverage and leave others facing higher out-of-pocket costs.
"We live in the wealthiest country on earth. Surely we can do better than what the Republican health care bill promises," said Senate Minority Leader Chuck Schumer, D-N.Y.
Four GOP conservative senators - Texas' Ted Cruz, Mike Lee of Utah, Kentucky's Rand Paul and Ron Johnson of Wisconsin - said the bill falls short of GOP promises to erase Obama's law and lower people's costs. But they said they were "open to negotiation and obtaining more information."
Sen. Dean Heller, R-Nev., facing a tough re-election fight next year, said he had "serious concerns' about the bill's Medicaid reductions.
"If the bill is good for Nevada, I'll vote for it and if it's not, I won't," said Heller, whose state added 200,000 additional people under Obama's law.
The House approved its version of the bill last month. Though he lauded its passage in a Rose Garden ceremony, Trump last week privately called the House measure "mean" and called on senators to make their version more "generous."
At the White House on Thursday, Trump expressed hope for quick action.
"We'll hopefully get something done, and it will be something with heart and very meaningful," he said
The bill would phase out the extra money Obama's law provides to states that have expanded coverage under the federal-state Medicaid program for low-income people. The additional funds would continue through 2020, and be gradually reduced until they are entirely eliminated in 2024.
Ending Obama's expansion has been a major problem for some GOP senators. Some from states that have expanded the program have battled to prolong the phase-out, while conservative Republicans have sought to halt the funds quickly.
Beginning in 2020, the Senate measure would also limit the federal funds states get each year for Medicaid. The program currently gives states all the money needed to cover eligible recipients and procedures.
The Senate bill would also reduce subsidies now provided to help people without workplace coverage get private health insurance, said Caroline Pearson, a senior vice president of the health care consulting firm Avalare Health.
Unlike the House bill, which bases its subsidies for private insurance on age, the Senate bill uses age and income. That focuses financial assistance on people with lower incomes.
Pearson said those subsidies will be smaller than under current law. That's because they're keyed to the cost of a bare-bones plan, and because additional help now provided for deductibles and copayments would be discontinued.
Under Obama's law, "many of those people would have gotten much more generous plans," she said.
The bill would let states get waivers to ignore some coverage requirements under Obama's law, such as specific health services insurers must now cover. States could not get exemptions to Obama's prohibition against charging higher premiums for some people with pre-existing medical conditions, but the subsidies would be lower, Pearson said, making coverage less unaffordable.
Like the House bill, the Senate measure would block federal payments to Planned Parenthood. Many Republicans have long fought that organization because it provides abortions.
It would also bar the use of the bill's health care tax credits to buy coverage that includes abortions, a major demand for conservatives. That language could be forced out of the bill for procedural reasons, which would threaten support from conservatives, but Republicans would seek other ways to retain the restriction.
The Senate would provide $50 billion over the next four years that states could use in an effort to shore up insurance markets around the country.
For the next two years, it would also provide money that insurers use to help lower out-of-pocket costs for millions of lower income people. Trump has been threatening to discontinue those payments, and some insurance companies have cited uncertainty over those funds as reasons why they are abandoning some markets and boosting premiums.
The nonpartisan Congressional Budget Office said the House bill would cause 23 million people to lose coverage by 2026. The budget office's analysis of the Senate measure is expected in the next few days.
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WASHINGTON - Senate Republicans would cut Medicaid, end penalties for people not buying insurance and erase a raft of tax increases as part of their long-awaited plan to scuttle President Barack Obama's health care law, congressional aides and lobbyists say.
After weeks of closed-door meetings that angered Democrats and some Republicans, Senate Majority Leader Mitch McConnell., planned to release the proposal Thursday. The package represents McConnell's attempt to quell criticism by party moderates and conservatives and win the support he needs in a vote he hopes to stage next week.
In a departure from the version the House approved last month, which President Donald Trump privately called "mean," the Senate plan would drop the House's waivers allowing states to let insurers boost premiums on some people with pre-existing conditions.
It would largely retain the subsidies Obama provided to help millions buy insurance, which are pegged mostly to people's incomes and the premiums they pay.
The House's tax credits were tied to people's ages, a change the nonpartisan Congressional Budget Office said would boost out-of-pocket costs to many lower earners. Starting in 2020, the Senate version would begin shifting increasing amounts of tax credits away from higher earners, making more funds available to lower-income recipients, some officials said.
The emerging Senate bill was described by people on condition of anonymity because they were not authorized to discuss it publicly.
Facing uniform Democratic opposition, the Senate plan would fail if just three of the chamber's 52 Republicans defect. More than half a dozen GOP senators have expressed problems with the measure, and a defeat would be a humiliating setback for Trump and McConnell on one of their party's top priorities.
"We have a responsibility to move forward, and we are," said McConnell, R-Ky.
GOP Senate leaders were eager for a seal of approval from Trump, who had urged them to produce a bill more "generous" than the House's.
"It's going to be important to get the president's support to get us across the finish line," No. 2 Senate GOP leader John Cornyn of Texas said Wednesday of White House officials.
Democrats say GOP characterizations of Obama's law as failing are wrong, while the Republican effort would boot millions off coverage and leave others facing higher out-of-pocket costs. The budget office said the House bill would cause 23 million to lose coverage by 2026.
The Senate measure would phase out the extra money Obama provided to expand the federal-state Medicaid program for the poor and disabled to millions of additional low earners. But it would be more gradual than the House bill, which cuts off the extra funds for new Medicaid beneficiaries in 2020. Republican senators from states that expanded Medicaid, such as Ohio's Rob Portman, want to extend that phase-out to seven years.
The Senate proposal would impose annual limits on the federal money that goes to each state for the overall Medicaid program, which would tighten even further beginning in 2025. Unlimited federal dollars now flow to each state for Medicaid, covering all eligible beneficiaries and services.
Like the House bill, the Senate measure would block federal payments to Planned Parenthood, two sources said. Many Republicans have long fought that organization because it provides abortions.
But it was unclear if, or how, the Senate would follow the House's path and forbid the use of health care tax credits to buy coverage that includes abortions. Such a prohibition is a major demand by conservatives, but special rules the Senate is using to ease passage of the legislation restrict the policy changes the measure can include.
The Senate would end the tax penalties Obama's law created for people not buying insurance and larger employers not offering coverage to workers. The so-called individual mandate - aimed at keeping insurance markets solvent by prompting younger, healthier people to buy policies - has long been one of the GOP's favorite targets.
To help pay for its expanded coverage to around 20 million more people, Obama's law increased taxes on higher income people, medical industry companies and others, totaling around $1 trillion over a decade. Like the House bill, the Senate plan would repeal or delay those tax boosts.
The House waiver allowing higher premiums for some people with pre-existing serious illnesses was added shortly before that chamber approved its bill last month and helped attract conservative support. It has come under widespread criticism from Democrats and helped prompt some moderate House Republicans to vote against the measure.
Conservatives like Sen. Rand Paul, R-Ky., have warned they could oppose the bill if it doesn't go far enough in dismantling Obama's law. Moderates including Sen. Susan Collins, R-Maine, have expressed concern that the measure would cause many to lose coverage.