US Senate Republicans moving forward on Obamacare repeal bill

By Kate Randall
13 June 2017

The US Senate “working group” drafting the chamber’s version of the bill repealing and replacing the Affordable Care Act (ACA) appears to be moving closer to a vote on the Senate floor. The Senate leadership hopes to bring it to a vote before the July 4 recess or shortly thereafter.

House Republicans passed the American Health Care Act (AHCA) early last month. That legislation guts Medicaid, the insurance program for the poor jointly administered by the federal government and the states that currently covers 74 million people.

The AHCA would cut $834 billion from Medicaid over a decade. The bill would effectively end Medicaid as an open-ended entitled program, by shifting federal funding to per capita caps or block grants, resulting in people who qualify being denied enrollment or having their benefits slashed.

The AHCA would also end the expansion of Medicaid under the program popularly known as Obamacare. The Congressing Budget Office (CBO) estimates that 14 million people would lose coverage under the AHCA by 2018; this figure would reach 23 million in 2026.

It would slash taxes for the rich, disproportionately taking aim at health coverage for the poor, older Americans and those with preexisting conditions.

Senate “moderates,” who originally signaled their opposition to ending the Medicaid expansion, are now indicating they could agree to phase out the program, but over a seven-year period. Senate Majority leader Mitch McConnell has proposed three years.

The bill will be sent to the CBO to score before the vote. In a major break with Senate protocol, Republicans say there will be no committee hearings or mark-ups for the bill, but it will be brought straight to the floor for a vote. Democrats argue this is a strategy for minimizing time for opposition to the bill to build.

Senate conservatives are still concerned about the longer Medicaid expansion phase-out, as well as moves to dial back the waivers in the AHCA that would allow states to repeal various Obamacare regulations.

The Senate bill is expected to allow states to seek exemptions from ACA rules on what insurance companies are required to cover, known as essential health benefits. These waivers would allow states to allow the sale of policies that don’t include benefits such as maternity care, prescription drugs, emergency room visits, substance abuse treatment, and other vital health needs.

As the Senate bill now stands, however, states would not be allowed to seek waivers preventing people with preexisting conditions to be charged more for coverage. “There has to be a give and take, and right now it seems like conservatives are being told just to take it all and not get anything,” Dan Holler, a spokesman for the conservative group Heritage Action for America, said on Thursday.

Also on the table is retaining some of the ACA taxes on the wealthy in place at least for a while to reach the $133 billion savings goal that is required under Senate rules. As the Senate bill is shaping up, however, it will retain the majority of the AHCA’s reactionary features.

In a conveniently timed move, more health insurance plans across the country are beginning to exit the Obamacare marketplace, citing uncertainty around the ACA’s future. This has prompted continual calls from the Trump administration and Republicans that Obamacare is “exploding” and “collapsing” and is in urgent need of repeal and replacement.

According to Vox, in the past week the number of US counties with zero health insurers signed up to sell coverage in 2018 has doubled. There are now 38,000 Obamacare enrollees across 47 counties where no insurers want to participate in the ACA.

Last week, Anthem announced that it would exit the Ohio marketplace, leaving 20 counties and 15,000 Obamacare enrollees with no 2018 plan options. If Anthem were to exit the rest of the states where it currently sells ACA plans, 300,000 Obamacare enrollees would be left without coverage.

Blue Cross Blue Shield Kansas City quit the exchanges on May 24, citing “the uncertain direction of the market.”

Andy Slavitt, who served as Medicare administrator in the Obamacare administration, spoke the truth when he told Vox, “We elected to have a system that is completely market-based so companies get to make individual decisions.”

In other words, the ACA relies on the insurance companies to volunteer to sell their products on these public marketplaces. Just as they are virtually unhindered in the premiums they can charge, they are free to exit the marketplaces when it is not in their best profit interest.

These insurance market conditions are making passage of the Senate bill, and its reconciliation with the House version, an easier process for Trump and the Republicans. While congressional Democrats have made a few protests, the repeal and replacement of Obamacare is for the most part flying under the radar.

While they concentrate on Trump administration ties to Russia and whether or not the president has taped recordings of his conversation with fired FBI Director James Comey, the Democrats and mainstream media have had little to say about legislation, in whichever form it emerges, that will result in millions of Americans losing their health care coverage, or being plunged into poverty due to high premiums and out-of-pocket costs.

This is because they agree in principle with the subordination of the health needs of the vast majority of the population to the profit requirements of the corporations that control the giant hospital chains, insurance companies, and pharmaceutical industries and the Wall Street banks that dominate the economy.