Kentucky is once again center stage in the national fight over health reform.
The fate of the newly-released Senate healthcare bill is shaping up as a high-stakes battle pitting the commonwealth's two Republican senators against one another – for now.
McConnell has a narrow needle to thread as he works to please moderate Republicans who want to preserve some protections offered by the Affordable Care Act and more conservative members who favor a cleaner break with Obama-era reforms. Despite bipartisan criticism for keeping negotiations under wraps, the majority leader praised the process that led to the draft in a Thursday floor speech.
"I'm pleased that we were able to arrive at a draft incorporates input from so many members, who represent so many different constituents, who are facing so many different challenges," McConnell said.
But talks appear far from the finish line, as Kentucky’s more libertarian-minded senator, Rand Paul, looks to flex some legislative muscle. Paul told news outlets he and at least two other senators oppose the bill in its current form, and that small coalition affords just enough leverage to put the measure in jeopardy.
"The reason we're coming out now is that now the discussion begins," the lawmaker said. "If the people that are in favor of the current bill know that there's not 50 votes for it, perhaps the discussion will begin in earnest to make the bill better."
McConnell has been pressing for a vote next week, but Paul says that “seems like a short time” and urged colleagues to read and fully digest the bill.
McConnell argues the Senate GOP healthcare bill will provide desperately-needed relief from a failing Affordable Care Act, but detractors see the bill as a potential disaster for the senator’s home state.
The leader says the draft healthcare measure delivers on Republican promises to take the pressure off individuals, families, and employers and free up states to better tailor coverage to residents’ needs. The measure, as written, repeals the individual and employer mandate, ends cost-sharing subsidies in 2020, phases out the Medicaid expansion, while maintaining some protections for people with pre-existing conditions.
"Obamacare isn't working by any measure. It has failed and no amount of eleventh-hour reality denying or buck-passing by Democrats is going to change the fact that more Americans are going to get hurt unless we do something," McConnell cautioned.
Contrast that with the tone from critics, who warn that recommended cuts to Medicaid and grants targeting the opioid abuse crisis would hit the commonwealth particularly hard.
"This would set the clock back substantially in Kentucky, more than any other state in the country actually," says Jason Bailey with the left-leaning Kentucky Center for Economic Policy. "This is the biggest threat that we face right now in terms of our economy and of our health."
Bailey says, as a poorer state, Kentucky risks losing the coverage and health gains it has tallied under the Democrats' reforms, which were enthusiastically embraced by former Gov. Steve Beshear.
Kentucky has played a pivotal role in the country’s ongoing debate over health reform. Under President Obama, the state was singled out as an ACA success story for its progress in cutting the uninsured rate. Now, the fate of the Republican overhaul hinges on just a handful of skeptical GOP lawmakers led by Kentucky’s junior senator.