Senate All Over the Map on Healthcare Reform

Lawmakers are traipsing along three wildly divergent paths toward fixing or replacing Obamacare. They have yet another bill to repeal the Affordable Care Act, a bipartisan action to stabilize state health insurance markets created by the ACA, and a bill to enact a single-payer system.

When it comes to healthcare reform, there are no safe spaces in Congress.

A new Affordable Care Act repeal effort sponsored by Republican Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada, and Ron Johnson of Wisconsin, reportedly has the support of 50 of the Senate’s 52 Republicans, according to published reports.

According to a media release issued by Sen. Graham’s office, the proposal repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states to help individuals pay for healthcare.

Specifically, the bill:

• Repeals the individual and employer mandates.
   
• Repeals the Medical Device Tax.
   
• Strengthens the ability for states to waive Obamacare regulations.
   
• Returns power to the states and patients by equalizing the treatment between Medicaid Expansion and non-expansion states through an equitable block grant distribution.
   
• Protects patients with pre-existing medical conditions.

The bill also eliminates the inequity of three states receiving 37% of Obamacare funds and brings all states to funding parity by 2026. As an example, Pennsylvania has nearly double the population of Massachusetts, but receives 58% less Obamacare money than Massachusetts, Graham said in his media release.

Critics of the legislation accused the Senate backers of making false claims to mitigate the harmful effects.

"In reality, the Cassidy-Graham bill would have the same harmful consequences as those prior bills,” according to an issues brief by the left-leaning Center on Budget and Policy Priorities.

“It would cause many millions of people to lose coverage, radically restructure and deeply cut Medicaid, eliminate or weaken protections for people with pre-existing conditions, and increase out-of-pocket costs for individual market consumers.”

Meanwhile, Majority Leader Mitch McConnell (R-KY) is said to be pushing for a floor vote as early as this week.

Bipartisan Compromise Sought

This latest – and perhaps last – repeal effort comes as other Senate Republicans are working Democrats to stabilize the wobbly state health insurance exchanges.  

Senate Health Committee Chairman Lamar Alexander (R-TN) said he is optimistic about the prospects for a bipartisan deal, and that a bill could be finalized this week.

“For seven years, hardly a civil word was spoken between Republicans and Democrats on the Affordable Care Act,” Alexander said in a press release.

“But for the last 10 days, senators from both sides of the aisle have engaged in serious discussions about what Congress can do between now and the end of the month to help limit premium increases for the 18 million Americans in the individual health insurance market next year and begin to lower premiums after that, and to prevent insurers from leaving the markets where those 18 million Americans buy insurance,” Alexander said.

The Tennessee Senator said that a series of hearings in the past month fleshed out “three themes” that represent a working consensus for stabilizing premiums in 2018.

“First, is Congressional approval of continued funding of the cost-sharing payments, for a specific period of time, that reduce co-pays and deductibles for many low-income Americans on the exchanges,” Alexander said.

“Second, senators from both sides of the aisle suggested expanding the so-called ‘copper plan’ already in the law so anyone—not just those 29 or under—could purchase a lower premium, higher deductible plan,” he said.

“The third – advocated by state insurance commissioners, governors, and senators from both sides of the aisle – is to give states more flexibility in the approval of coverage, choices, and prices for health insurance.”

Single-payer Bill Introduced

And out in Left Field, Sen. Bernie Sanders (I-VT) has introduced “Medicare for All” legislation. Single payer has no chance of passing a Republican-controlled Congress, but the bill is red meat for Sanders’ supporters, and a ploy to energize the Democratic and Progressive base for the 2018 and 2020 general elections.

In an op-ed piece last week in the New York Times, shortly after he introduced the bill, Sanders described “a pivotal moment in American history.”

“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” Sanders asked, “Or do we maintain a system that is enormously expensive, wasteful and bureaucratic, and is designed to maximize profits for big insurance companies, the pharmaceutical industry, Wall Street and medical equipment suppliers?”

The introduction of the single-payer bill last week prompted a Twitter spat between Sanders and President Donald Trump, who tweeted: "Bernie Sanders is pushing hard for a single payer healthcare plan - a curse on the U.S. & its people." 

To which Sanders immediately responded in a tweet: “No Mr. President, providing healthcare to every man, woman and child as a right is not a curse, it's exactly what we should be doing.”