Senate conservatives are signaling that a key way to win their support for a Senate healthcare bill is to repeal more of Obamacare’s insurance mandates, but they aren’t saying if a requirement that shields sick people from high premiums must be on the table.
Conservative holdouts have complained in recent days that the draft healthcare bill announced last week keeps too many of Obamacare’s insurer mandates. However, some of the key holdouts have not said whether the Senate should let states opt out of a mandate called community rating that forbids insurers from charging sick people more money.
A few hours after the Senate GOP leadership introduced its draft healthcare bill, four conservative senators announced they were opposed to it in its current form. The holdouts are Republican Sens. Ron Johnson of Wisconsin, Ted Cruz of Texas, Rand Paul of Kentucky and Mike Lee of Utah.
Several of the holdouts complained that the bill doesn’t do enough to lower premiums.
“My central focus from day one has been the need to lower premiums to make health insurance more affordable for families who are struggling,” Cruz said shortly after leaving a Senate luncheon Tuesday. “There is not enough in the current draft to do that.”
McConnell announced at that luncheon that he did not have the votes for the healthcare legislation to pass and was delaying a planned vote this week until after the July 4 recess.
Several senators said the bill leaves in too many of Obamacare’s insurer mandates.
“We have to repeal more regulations,” Paul said on Monday.
But some holdouts declined to say if they were in favor of the House approach of letting states waive community rating, a mandate that forces insurers to charge the same rate regardless of health history.
The House bill that lawmakers passed last month includes a waiver that would let states opt out of the mandate alongside a mandate that insurers cover 10 essential health benefits such as mental health, maternity care and hospitalization.
But the Senate bill lets states waive only the essential health benefits and a requirement that lets individual and small group plans cap annual out-of-pocket costs.
When asked whether community rating waivers should be added to the bill, Cruz said only that there are a “host of policy tools that we should use to expand flexibility to expand choice and increase options to lower premiums.”
Johnson also railed against the mandates on Monday.
“I would recommend people go back to what were the conditions prior to Obamacare, embrace those conditions and get rid of those mandates that drive up the cost of insurance,” he said.
Johnson added that high-risk pools should be set up to help people with pre-existing conditions. The House bill included about $23 billion for high-risk pools, but the Congressional Budget Office said the funding is nowhere near enough to ensure that those people have affordable coverage.
Johnson was then asked whether the final bill has to repeal community rating.
“In the end I will make the decision based on whether or not we are better off tomorrow with whatever we are voting on than we are today,” he responded.
Paul said a key problem with the bill is that it repeals only two of Obamacare’s 12 insurer mandates.
He added that pre-existing conditions could be addressed by letting people on the individual market enroll in group plans or association plans. With those plans, a group of people on the individual market, which is for people who don’t get insurance through work, or small businesses band together to create an association and get more clout and buying power.
“That should be the answer to pre-existing condition,” he said. “If there are people left behind, maybe they get absorbed by Medicaid.”
But it is not clear if repealing more of Obamacare’s regulations would cost support from centrist Republicans.
Already three centrists — Susan Collins of Maine, Rob Portman of Ohio and Shelley Moore Capito of West Virginia — oppose the Senate bill partly because of Medicaid cuts.
Paul said Republican leaders could look for ways to find common ground, using the example of expanding health savings accounts, which is a change that both conservatives and centrists like.
“One of the ways to get to a bill that everybody agrees to is to keep getting it narrower and narrower,” he said.
