Senate Republicans on Thursday morning are expected to release an adjusted healthcare bill that would repeal and replace portions of Obamacare, even as factions of the party remain deeply divided over its rumored contents.
The latest draft is expected to include an amendment proposed by conservative Sens. Ted Cruz of Texas and Mike Lee of Utah that would allow health insurance companies to offer less-expensive plans that do not include Obamacare's essential health benefits as long as they provide at least one plan that includes them.
It is also expected to include a $45 billion fund for states to use in the battle against the opioid epidemic and would maintain Obamacare's 3.8 percent investment tax and 0.9 percent Medicare surtax on upper-income earners.
Other parts of the legislation are expected to remain largely similar to the version announced in late June, which would repeal the individual mandate requiring people obtain insurance coverage or pay a fine. It also is expected to keep in place changes to Medicaid, including a rollback of federal support from states that have expanded it to low-income residents. It is expected to give states a fixed rate of funding for traditional Medicaid rather than matching the need each year and to tie the program's growth rate to overall inflation rather than to its current, faster-increasing medical inflation.
"It is a variation of what we already had," said Sen. Ron Johnson, R-Wis., speaking Wednesday. "This is going to be a much closer variation. I don't think there will be that many dramatic changes."Before heading to a floor vote, which Senate leaders hope to have next week, Republicans will need to vote on a motion to proceed that would bring the legislation forward for debate. Several Republicans are likely to wait to voice their support or opposition for proceeding until they see how the Congressional Budget Office scores the bill early next week.
By using the CBO score as a guide, Republicans will be able to assess how many more people would be uninsured than under current law and what to expect with premium rates and federal spending. The CBO score is expected to include two versions, one that includes the Cruz-Lee amendment and one that does not. Critics, including centrist Republicans and the insurance industry, already say that they believe the Cruz proposal would make coverage prohibitively expensive for people with pre-existing illnesses.
Johnson said ahead of the bill's release that his intentions were to vote for the motion to proceed. After the first draft was released in June, he said he did not support moving forward, a decision he said was rooted in the one-week timeline by which Senate leaders wanted to pass the legislation.
"My whole objection was a week after we got a discussion draft to be voting on it didn't made sense to me," he said.
Sen. Mike Rounds, R-S.D., said he would vote for the motion.
"We're moving in the right direction in my opinion," he said. "Most of us want to get in and start making changes or at least try to improve what's there."
Senate Majority Leader Mitch McConnell, R-Ky., was not previously able to gain enough support for a former version of the bill and moved back the Senate's August recess partly to work on coming to an agreement.Republicans are advancing the bill through reconciliation, which requires only a simple majority vote rather than the 60 typically needed to kill a filibuster. Because no Democrats will vote for a bill that repeals Obamacare, Republicans can pass a law only with their own party, which holds a narrow majority, at 52 seats.
Divisions on the previous version have become clear. Conservatives say that bill did not do enough to repeal Obamacare and to reduce premiums, while centrist are concerned about projections from the Congressional Budget Office that estimated 22 million more people would be uninsured by 2026 than under current law.
If Republicans are unable to pass a bill, McConnell has said, Republicans would have to work with Democrats to fix the Obamacare exchanges, which are facing double-digit increases in premiums and insurer exists. Some GOP senators, including Sens. Lindsey Graham of South Carolina and and Susan Collins of Maine, are speaking with Democrats about a possible solution.
Sen. Rand Paul, R-Ky., told reporters Wednesday that on the basis of what he knew so far he would be voting against the bill. He said that if Republicans couldn't come to an agreement, they should pass the more extensive repeal bill that they sent to former President Barack Obama in 2015 and then work with Democrats on additional spending possibilities.
Sen. Richard Shelby, R-Ala., noted that Republicans were elected on promises to repeal Obamacare."I wish we had repeal straight up, and that is what I would vote for today," he said.
President Trump addressed the delay on healthcare in an interview with CBN News that aired Wednesday, saying that when Republicans voted to repeal Obamacare in 2015, they knew it would be vetoed by Obama.
"Now we have a president that's waiting to sign it," he said. "I have pen in hand, so now it means something. You know, those other times, those many, many times, that they passed it, it didn't mean anything."
Trump noted the division within his party and said people would be upset if Republicans were not successful in passing a bill.
"We need almost all of them," he said of the 52 Republican senators. "You need almost all of them, and that's the holdup. And states are somewhat different. But with all of that being said, it has to get passed. They have to do it. They have to get together and get it done."