Senate Republican leader Mitch McConnell released his new but still-reeling health care bill Thursday, bidding for conservative support by letting insurers sell low-cost, skimpy policies and reaching for moderates with added billions to combat opioid abuse and help states rein in consumers' skyrocketing insurance costs.
However, allowing insurers to offer bare-bones plans threatens to alienate moderates and perhaps other conservatives. And the measure retains cuts in Medicaid — the health insurance plan for the poor, disabled and nursing home patients — that moderate Republican senators have fought.
The 172-page legislation, the Senate GOP's plan for rolling back much of President Barack Obama's health care law, faces a do-or-die vote next week on which McConnell has no margin for error. Since Democrats uniformly oppose the effort, McConnell needs the votes of 50 of the 52 GOP senators to prevail, and two seem certain to vote "no" — conservative Sen. Rand Paul of Kentucky and moderate Sen. Susan Collins of Maine.
Underscoring the measure's dicey prospects, No. 3 Senate Republican leader John Thune of South Dakota said, "We've got a long way ahead of us yet. The floor is going to be a wild place next week."
Seeking to rally support, McConnell, R-Ky., reminded GOP senators that obliterating the 2010 statute has been a central tenet for the party's candidates.
"This is our chance to bring about changes we've been talking about since Obamacare was forced on the American people," he said.
But Democrats chose a different word to describe the measure, one which President Donald Trump himself used to describe the House-passed version of the measure despite having applauded it previously.
"The new Republican Trumpcare bill is every bit as mean as the old one," said Senate Minority Leader Chuck Schumer of New York. He said the provision allowing scanty coverage makes it "even meaner."
Conservative Sen. Ted Cruz, R-Texas, has demanded language letting insurers sell plans with minimal coverage, as long as they also sell policies that meet strict coverage requirements set by Obama's 2010 statute. Moderate Republicans have objected that the idea would make policies excessively costly for people with serious illnesses because healthy people would flock to the cheaper coverage.
Sen. Mike Lee of Utah, who'd partnered with Cruz, tweeted that the version they crafted wasn't put in the bill, adding, "Something based on it has, but I have not seen it or agreed to it."
A summary of the bill said some stripped-down policies would cover three primary care visits per year and limit out-of-pocket costs, and said consumers could use federal tax credits to help pay for them.
But the Cruz provision appeared in the legislative text in brackets, meaning specific language was still being composed. That could give McConnell, Cruz and other conservatives time to work out a provision with broader support.
The retooled measure retains McConnell's plan to phase out the extra money 31 states have used to expand Medicaid under Obama's statute, and to tightly limit the overall program's future growth. Since its creation in 1965, the program has provided open-ended federal funds to help states pay the program's costs.
The rewritten package would add $70 billion to the $112 billion McConnell originally sought that states could use to help insurers curb the growth of premiums and consumers' other out-of-pocket costs.
It has an added $45 billion for states to combat the misuse of drugs like opioids. That's a boost over the $2 billion in the initial bill and an addition demanded by ok
Republicans from states in the Midwest and Northeast that have been ravaged by the drugs.
To help pay for the added spending, the measure would retain three tax increases Obama's law slapped on higher- earning people to help finance his law's expansion of coverage. Under the current statute, families earning more than $250,000 annually got a 3.8 percent boost on their investment income tax and a 0.9 percent increase in their payroll tax. Obama also imposed a new tax on the salaries of high-paid insurance executives.
The measure would eliminate other tax boosts Obama levied on insurers, pharmaceutical producers and other health industry companies.
The revised bill would also allow people to use money from tax-favored health savings accounts to pay health insurance premiums, another favorite proposal of conservatives.
McConnell's new bill offered only modest departures from the original version, which he yanked off the Senate floor two weeks ago to avoid certain defeat at the hands of a broad range of unhappy Republicans.
The reworked measure's key elements remain. It would ease Obama's requirements that insurers cover specified services like hospital care, erase Obama's penalties on people who don't buy coverage and make federal health care subsidies be less generous.
Trump said Wednesday he will be "very angry" if the Senate fails to pass the health care measure and said McConnell must "pull it off."
Paul told reporters the revised measure has nothing "remotely resembling repeal." Collins has long complained the measure will toss millions off coverage and objected to its Medicaid cuts.