CBO figures add wrinkle for senators

Sen. John Cornyn, R-Texas, said Thursday that, while “there’s nothing final,” senators were narrowing their differences on a health care bill.
Sen. John Cornyn, R-Texas, said Thursday that, while “there’s nothing final,” senators were narrowing their differences on a health care bill.

WASHINGTON -- Republican senators conceded Thursday that a new analysis of the House GOP health care bill has complicated their effort to dismantle the 2010 health care law.

"It makes everything harder and more difficult," Sen. Dean Heller, R-Nev., said of a Congressional Budget Office analysis that projects that the House bill would cause 23 million Americans to lose insurance coverage by 2026 and create prohibitively expensive costs for many others.

"There's blinking yellow lights throughout the whole thing," Sen. Patrick Toomey, R-Pa., said of the report by lawmakers' nonpartisan fiscal experts.

Congress now begins a weeklong recess, with GOP senators still hunting for a health care overhaul plan that can win the support of no fewer than 50 senators, plus Vice President Mike Pence's tie-breaking vote.

[INTERACTIVE: Compare new health care bill with Affordable Care Act]

The analysis of the House-passed plan gives senators a numerical starting point for their own work and makes the Republican health care drive a larger target for Democratic attacks.

"The bottom line is very simple. Unless you're a healthy millionaire, Trumpcare is a nightmare," said Senate Minority Leader Charles Schumer, D-N.Y. "And I think that's why our Republican colleagues are having such trouble putting together their own bill."

The House bill would relax many of the Patient Protection and Affordable Care Act's consumer protections, kill its mandate that people buy coverage, trim federal subsidies for insurance purchasers, and cut the Medicaid program for lower-income and disabled people.

Senate Republicans have been holding private meetings to narrow differences and produce their own health care package. They've said it will differ markedly from the House measure, including easing some Medicaid reductions and focusing tax credits for buying coverage more at poorer people.

The No. 2 Senate GOP leader, John Cornyn of Texas, expressed optimism that senators were narrowing their differences and said staff members could "start work" over the recess on writing some language of a Senate bill, but he conceded, "There's nothing final."

Senate Finance Committee Chairman Orrin Hatch, R-Utah, said, "We're still a ways away from having solutions here."

That's prompted increased talk of possibly breaking out a less ambitious bill aimed at keeping insurance markets stable over the next two years, Republicans say. That could involve providing money to insurance companies so they can contain customers' costs, and perhaps retaining the Affordable Care Act's individual mandate, which imposes tax penalties on people who go uninsured.

Short-term idea

A Senate plan is likely to continue subsidies that help low-income Americans with co-pays and deductibles, said third-ranking Republican John Thune of South Dakota. White House budget director Mick Mulvaney said Thursday that the administration hasn't committed to paying subsidies due in June -- which would create additional uncertainty for insurers as they set rates for next year.

"There clearly has to be a short-term solution that works with the transition until some of our long-term policy changes can take effect," Thune told reporters. "There's got to be certainty in the marketplace."

The private Senate GOP negotiations include a 13-member leadership-controlled working group as well as almost daily closed discussions among all Senate Republicans. In addition, Republican Sen. Susan Collins of Maine has convened bipartisan talks with about a dozen senators.

Senators have indicated that the talks have spent little time on perhaps the toughest issue: How to pay for a plan that would cover more people and offer lower premiums than the House bill. That would require retaining some of about $800 billion in Affordable Care Act taxes that the House measure repeals, or finding other cost savings in the federal budget.

"I think we ought to try to look for savings anywhere we can find them," Hatch said. "But my experience is that we don't find many savings."

Members of the 13-member working group and in Collins' group say there is little interest in using state-run high-risk insurance pools to cover the chronically ill and those with pre-existing conditions. The House bill allows states to opt out of the Affordable Care Act's ban on higher premiums for those with pre-existing conditions if they provide high-risk pools, with federal funding help.

Because of evidence that high-risk pools are expensive and have been underfunded, Senate Republicans say they're weighing using reinsurance instead. That approach would provide money to individual-market insurers to help pay for high-cost customers -- an effort to discourage insurers from setting higher premiums for those people.

"High-risk pools have not had a stellar record," said Sen. Bill Cassidy, a Louisiana Republican, who is part of the bipartisan negotiations. "I think reinsurance is a better way to go."

Arkansans react

The budget office concluded that on average, premiums for people buying their own insurance would eventually be lower than under the 2010 law under the House bill. That would fulfill a chief goal for many Republicans.

But the report said the lower prices would arise largely because many consumers would be buying skimpier coverage and others wouldn't be able to afford it and would leave the market, particularly the very ill, lower-earners, and people in their 50s and early 60s.

Many people in states that under the bill could permit slimmer benefits and higher premiums for customers with pre-existing conditions "would face substantial increases in their out-of-pocket costs," the report said. It said states could choose to let insurers charge extra for maternity coverage with costs that could exceed $1,000 monthly.

Sen. John Boozman, R-Ark., said the Congressional Budget Office figures are about what people expected them to be.

"I don't know that anybody was really surprised," he said, noting that the Congressional Budget Office had made similar predictions about a previous version of the legislation.

Caroline Rabbitt, a spokesman for Sen. Tom Cotton, R-Ark., questioned the reliability of the figures.

"As we saw with the passage of Obamacare [the Affordable Care Act] in 2010, the CBO score isn't always the most realistic indication of a bill's impact," she said in a written statement.

She added that Cotton "is working diligently with his colleagues in the healthcare working group" to craft a replacement for the Affordable Care Act.

Premiums in Arkansas rose 128 percent between 2013 and 2017, Boozman said, pointing to a study this week by the U.S. Department of Health and Human Services' office of the assistant secretary for planning and evaluation.

"We've got significant problems with the present system," he said.

Congress' top two Republicans ignored the report's findings in their public comments Thursday.

Senate Majority Leader Mitch McConnell, R-Ky., spoke for several minutes on the Senate floor without even mentioning the analysis. Instead, he discussed a Trump administration report showing that premiums have grown in recent years and accused Democrats of trying to "blame someone other than themselves for the failures of Obamacare."

House Speaker Paul Ryan, R-Wis., cited the flexibility the House bill would give states to determine coverage requirements and said, "That's why I'm actually comforted by the CBO report which shows, yeah, we'll lower premiums."

Information for this article was contributed by Alan Fram and Ricardo Alonso-Zaldivar of The Associated Press; and by Laura Litvan, Doni Bloomfield and Arit John of Bloomberg News.

A Section on 05/26/2017

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