Five takeaways from the GOP’s healthcare reboot

Senate Republican leaders are pushing ahead with their plan to vote next week on a healthcare reform bill after releasing a revised version of the legislation Thursday to mixed reaction.

For three weeks, leadership has been pulling concerned members into their offices to discuss changes to the legislation that would repeal and replace ObamaCare. The tweaks released Thursday were aimed at shoring up support within a Republican conference that has been deeply divided over what to do.

Just a few hours after the new bill was released, two senators said they wouldn’t vote for a motion to let the Senate debate the Republican healthcare bill; that means Senate Majority Leader Mitch McConnell (R-Ky.) can only afford to lose one more vote and still have Vice President Pence break a 50-50 tie.

{mosads}Other moderates held their fire on the bill, giving McConnell a chance to win them over in the coming days. And in a big win for GOP leadership, Sen. Ted Cruz (R-Texas) said he would vote for a motion to proceed to the bill, likely neutralizing conservative opposition. 

Here are five takeaways from the big unveiling.

It includes a provision key to earning conservative support

An amendment pushed for weeks by Cruz could go a long way toward gaining conservative support for the legislation.

A version of the Cruz proposal that was included in the bill would let insurers offer insurance plans that don’t comply with ObamaCare regulations, as long as they also sell plans that do.

“I think this new bill represents a substantial improvement over the previous version,” Cruz told reporters after leaving a briefing on the draft Thursday.

“If this is the bill, I will support this bill. If it’s amended, and we lose the protections that lower premiums, my view could well change.”

Another conservative holdout on the bill, Sen. Mike Lee (Utah), worked with Cruz on the amendment, but has not yet said if he supports the bill overall.

“The new Senate health care bill is substantially different from the version released last month and it is unclear to me whether it has improved,” Lee said in a statement.

“I will need time to study the new version and speak with experts about whether it does enough to lower health insurance premiums for middle class families.”

Several centrist Republicans have expressed concerns about how this provision would affect people with pre-existing conditions, however, and it’s unclear whether they will accept its inclusion.

The bill would also create a fund to help insurers cover people with expensive medical costs, but it’s unclear if that will be enough to appease moderates.

Medicaid cuts are largely kept in place.

The updated legislation left the deep Medicaid cuts from the first version of the bill essentially unchanged, which could be a big problem for moderate GOP senators like Rob Portman (Ohio), Shelley Moore Capito (W.Va.) and Lisa Murkowski (Alaska).

The legislation would put a cap on federal Medicaid reimbursement for states, dramatically changing the program from an open-ended entitlement. It would end ObamaCare’s increased funding for states to expand Medicaid by 2024 and cut the rate of inflation.

Taken together, the bill would cut $772 billion from Medicaid funding over a decade and result in 15 million fewer people enrolled, according to the Congressional Budget Office.

Medicaid has always been one of the thorniest issues for Republicans to navigate during ObamaCare repeal. Twenty GOP senators represent states that expanded Medicaid. Since the original legislation was released in June, some of those senators have said the Medicaid cuts are their top reason for opposing the bill.

Murkowski as recently as Wednesday had argued that Medicaid reforms should be handled separately from the legislation repealing and replacing ObamaCare.

The lack of major revisions to the Medicaid provisions has already cost GOP leaders the support of Sen. Susan Collins (Maine), who announced she wouldn’t support a procedural motion to allow debate on the bill. 

By keeping the cuts in place, McConnell is banking on moderates flipping to yes without their top priority being addressed.

Sen. Dean Heller (R-Nev.) previously said he wouldn’t vote for the bill in its current form, citing the phaseout of extra federal funds for Medicaid expansion as a main concern. Heller on Thursday said he was undecided about moving to proceed. Portman also said he was undecided on the motion to proceed.

The bill includes more money to combat the opioid crisis.  

Originally, the Senate healthcare bill included $2 billion to help combat the opioid crisis, a far cry from the $45 billion Portman and Capito were pushing for.

The new version has exactly that: $45 billion. 

But that doesn’t mean the funding will be enough money to win their support. On Thursday, neither senator would say whether they would support a motion to proceed to the bill. 

In a statement, Portman said, “I opposed the last draft of the Senate health proposal because I had concerns about the measure’s Medicaid policies, especially those that impact drug treatment for those suffering from addiction.”

Ohio Gov. John Kasich (R) has called for a bipartisan compromise on healthcare and has also urged Portman not to be won over by minor concessions.

“I told him, ‘If they hand you a few billion dollars on opioids … that’s like spitting in the ocean'” compared with the billions the bill would cut from Medicaid, Kasich told reporters last month.

Previously, Capito indicated bolstering the opioid fund probably wouldn’t be enough to garner her support.

“More opioid funding would be very good and very beneficial, but the core for me is the Medicaid provision,” Capito said.

She added: “If you can’t access the treatment, it’s not going to do you any good.”

The bill keeps ObamaCare taxes on high earners.

Republicans reversed from their initial draft and decided to keep ObamaCare’s taxes on high earners.

The bill will keep ObamaCare’s 3.8 percent net tax on investment income and a 0.9 percent payroll tax on individuals making more than $200,000.

The legislation also keeps an ObamaCare rule that prevents insurance companies from writing off compensation that they pay their executives.

The initial draft scrapped all ObamaCare taxes, including those on high earners.

Sen. Bob Corker (R-Tenn.), who pushed McConnell to keep the taxes on high earners, said many senators had an issue with giving rich people a tax break while reducing subsidies for low-income people. 

“I think that was something that was felt by many, many, many people in our caucus,” Corker told reporters Thursday.

The measure still repeals other ObamaCare taxes that Republicans say directly impact consumers and drive up premiums, including taxes on the medical device and prescription-drug industries. 

Much of ObamaCare would remain.

The bill probably can’t escape the “ObamaCare lite” moniker.

It keeps the structure of ObamaCare’s tax credits to help low-income Americans afford insurance in place, though they would be less generous. A tax on high earners would remain. In short, it’s not a straight repeal of the law.

This means getting Sen. Rand Paul’s (R-Ky.) vote is likely out of the question. Previously, he’s suggested changes that haven’t made it into the bill, such as eliminating a stability fund, repealing more ObamaCare taxes and dropping the continuous coverage provision.

“The thing is that I thought we were pretty clear,” Paul said after the closed-door GOP meeting. “We promised to repeal ObamaCare; this frankly doesn’t repeal ObamaCare. It keeps the subsidies, it keeps the taxes, it keeps the regulations. I think we’re going back on a promise.”

When asked if this bill was worse than ObamaCare, Paul replied, “Yes.”