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Competing plans deal Senate health-care push a surprise setback

WASHINGTON — The Senate GOP's push to rewrite the Affordable Care Act suffered an ill-timed setback Thursday, as two centrist Republicans announced plans to offer their own health care plan just as leaders released an updated bill of their own.

The move by Sens. Bill Cassidy, La., and Lindsey Graham, S.C., to debut their health-care proposal on CNN moments before Senate Majority Leader Mitch McConnell, R-Ky., was set to brief members demonstrated how divided the majority remains in its quest to overhaul former president Barack Obama's signature health care law.

In a joint interview with CNN Thursday, Cassidy and Graham said that they would take the billions of dollars the federal government now receives in taxes under the ACA and direct that revenue to the states.

RELATED CONTENT: Sen. Marco Rubio is on board with the plan to offer bare-bones health care policies

"We're going to see which one can get 50 votes," Graham said, referring to the number of GOP senators needed to approve any bill in the Senate, given that Vice President Pence is prepared to cast the tiebreaking vote. "We're not undercutting him; he's not undercutting us."

"Our problem has been trying to combine tax reform with replacement of Obamacare," said Cassidy. "We're giving the money back to the states. The states can do what they want to do. A blue state can do a blue thing; a red state can do a red thing."

The surprise announcement came just before Senate GOP leaders released a revised health-care proposal Thursday that would allow insurers to sell austere plans that do not comply with requirements imposed under the Affordable Care Act.

Sen. Ted Cruz, R-Texas, who authored the provision letting insurers offer minimalist coverage plans on the federal health-care exchange, said in a radio interview that the fact that the new draft "will include" a version of his amendment "is a very positive development."

"I think we're making serious progress toward coming together and unifying our conference," said Cruz, who appeared on the 550 KFYI Phoenix radio host Mike Broomhead show along with Sen. Jeff Flake, R-Ariz. Neither lawmaker has yet to endorse the GOP plan to rewrite the Affordable Care Act.

Details of the proposal were closely guarded Thursday morning, and it was unclear what precise form the Cruz idea would take in the final bill.

Cruz's plan would allow insurers to sell plans that don't comply with Obamacare coverage requirements, such as mandated coverage of preventive care and mental and substance abuse treatment, provided they offer at least one that does.

"What it is focused on, front and center, is lowering premiums," Cruz said of his amendment. "You the consumer, should have the freedom to purchase the insurance you want."

Critics, including insurers, believe that providing the option of skimpier plans would draw younger, healthier consumers into a separate risk pool. That development would drive up rates for the Americans buying more comprehensive coverage on the individual market, which could in turn destabilize the entire market.

Sen. John Thune, R-S.D., a top McConnell deputy, said leaders are waiting for the Congressional Budget Office analysis next week before settling on what elements will be included in the final Senate bill. One option Thune raised was a fund to help offset the cost of premiums for people who would fall into high-risk pools under the Cruz plan. Thune said that money would "help shore up the markets," but he declined to say how they would be structured.

"At this point I don't think anything is final," Thune said. "Not until we get on the bill next week and get to amend it."

Senate leaders are also leaving themselves the option of jettisoning the Cruz proposal after they get the nonpartisan CBO score, that will gauge the Cruz amendment's impact on both the budget and the overall number of uninsured.

McConnell is willing to preserve a pair of taxes on wealthy Americans that would have been repealed under the original bill to help subsidize the cost of middle-Americans' premiums, according to several Republicans briefed on the bill. These lawmakers and aides said the revised bill would also provide $45 billion in funding to address opioid addiction - a key priority for GOP Sens. Rob Portman, Ohio, and Shelley Moore Capito, W.Va.

Senate Majority Whip John Cornyn, R-Texas, said Thursday that he expects the CBO will release two scores for the bill but would not confirm what those scores would include or when it will be released.

"We are expecting a CBO score but I can't tell you exactly what the format will be," Cornyn told reporters. "The Lee and Cruz amendment will be scored."

The Cruz amendment underwent several iterations in recent weeks and the proposal is still being considered by analysts at the CBO, according to two GOP aides familiar with the process. As a result, the CBO is expected to release one score without the Cruz provisions and another that will provide further details on the Cruz amendment.

The changes remain controversial among moderates who worry the Cruz proposal could drive up premiums for sicker, older Americans. Cornyn stopped short of promising the changes would be enough to ensure the bill will pass.

"We will have the votes when we start voting," Cornyn said.

In a sign of how undecided many GOP senators remain, Flake - who backs Cruz's proposal - said in Thursday's interview that he remains concerned about the large cuts to Medicaid funding contained in the bill.

"There is a lot of concern in Arizona on the Medicaid side," said Flake, whose state expanded Medicaid to able-bodied, childless adults under the ACA and stands to lose billion in federal funds under the Senate bill. "This amendment does not affect the Medicaid side at all."

What's in McConnell's revised GOP health bill?

The latest changes to the Senate Republican health care bill are geared to increasing access to bare-bones private insurance. There's also an additional $45 billion to help states confronting the opioid epidemic.

But Senate Majority Leader Mitch McConnell, R-Ky., would keep in place Medicaid cuts that GOP governors and Senate moderates have objected to. No Democrats are supporting the plan.

Here's a look at some of the latest changes:

• A major change to health savings accounts would allow consumers to use the tax-sheltered arrangements to also pay for health insurance premiums. Currently health savings accounts can only be used to pay out-of-pocket costs not covered by insurance, such as deductibles and copayments for medical services.

• More money for states to help lower health insurance costs for residents who buy their own individual policies. The bill would add another $70 billion to a market stability fund of $112 billion in the original Senate bill.

• Another $45 billion over 10 years for states battling the opioid epidemic, targeted to paying for substance abuse treatment and recovery. The original bill only provided $2 billion.

• More ways for consumers to buy lower-premium, bare-bones insurance. Consumers could use their federal tax credits to buy high-deductible plans that cover three routine doctor visits per year. Current limits on who can use federal tax credits to purchase so-called catastrophic insurance would be eased.

• A version of Texas Sen. Ted Cruz's proposal allowing insurers to sell skimpy plans, provided they also offer at least one option that meets the requirements of current law. The latest approach would provide funding for insurers to help offset the cost of covering sicker people remaining in comprehensive plans.

Competing plans deal Senate health-care push a surprise setback 07/13/17 [Last modified: Thursday, July 13, 2017 2:05pm]
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