McConnell courts GOP centrists for health bill

Senate Majority Leader Mitch McConnell (R-Ky.) on Wednesday was focused on winning the support of GOP centrists for an ObamaCare repeal-and-replace bill that his members are expected to see on Thursday.

McConnell can only afford two defections, and votes from conservative Sens. Rand Paul (R-Ky.) and Mike Lee (R-Utah) were in serious doubt as GOP leaders sought to appease moderate Republican demands.

{mosads}At a special lunch briefing, Republican senators discussed making tax credits for low-income and older Americans more generous compared to the House-passed American Health Care Act. The tax credits will be adjusted to reflect income and age to soften the potential impact on poor seniors.

The increased support for low-income Americans is intended to placate moderate Republicans who are concerned about phasing out ObamaCare’s generous federal assistance for expanded Medicaid enrollment.

“We hope to cover more people than the House bill,” said Senate Republican Whip John Cornyn (Texas).

The balancing act between conservatives and centrists is a crucial test of McConnell’s leadership, with every move toward one side risking votes on the other.

McConnell himself worked to lower expectations just months ago, acknowledging the difficulties the Senate faced in putting together an ObamaCare repeal-and-replace bill that could win 50 votes. (Vice President Pence would then be called in to break a tie.)

The Republican leader is now nearing a vote, which is expected to take place next week.

And while many GOP senators are undecided, none have yet stated unequivocally that they will vote no.

Republican senators will find out what exactly is in the bill at a special meeting scheduled for 9:30 a.m. on Thursday.

The legislative text will be posted publicly, according to a senior Senate aide, who said the document will be far smaller than the 2,700-page ObamaCare bill.

The bill is widely expected to undergo more changes before a vote next week.

McConnell faces one potential procedural objection in language that would restrict tax credits from being used to buy insurance plans that cover abortion services.

If the Senate parliamentarian rules that language cannot be included in the bill under budgetary rules, conservative anti-abortion advocacy groups could come out against the bill and sink it.

“I believe that did not pass through the parliamentarian’s review, so I don’t expect that to be in there,” Sen. Susan Collins (R-Maine) said Wednesday.

Because Republicans are using a special budgetary process known as reconciliation to pass the bill with a simple majority vote, it must meet a six-part test known as the Byrd Rule. The toughest requirement to fulfill states that provisions included in the legislation must have more than an incidental budgetary impact.

A Republican senator who attended the briefing on the tax credits said the abortion coverage language as of Wednesday afternoon was still in the bill and negotiators were working on a way to protect it from running afoul of Senate procedure.

Procedural obstacles could also imperil language defunding Planned Parenthood, another top priority of conservatives who want to restrict abortion.

The Senate parliamentarian in 2015 allowed similar language related to Planned Parenthood in the ObamaCare repeal bill that the Senate and House passed and then-President Barack Obama vetoed.

Medicaid is another thorny issue. Twenty Republican senators represent states that expanded Medicaid enrollment under ObamaCare. About a half dozen of them worry that ending generous federal assistance for new enrollees will shift big cost burdens onto their home states.

McConnell has addressed their concerns by beginning the phase-out of expanded federal assistance at a later date than the House bill, which caps the program in 2020.

One Republican senator familiar with the legislation said he expects the phaseout will begin in 2021 and be implemented more slowly than in the House bill.

“It will mean more money for the states up front,” said the lawmaker.

Some lobbying sources said the draft on Thursday could include a three-year phaseout of the funding for Medicaid’s expansion under Obama-Care. But they said the phaseout could still be made longer before a final vote to win over moderates.

To placate conservatives, McConnell has agreed to use a different formula than the House for indexing Medicaid to inflation, which could lower the bill’s costs.

Republicans who support this reform note it will not go into effect until 2025, giving policymakers plenty of time to assess the impact of the healthcare reform legislation before curbing the cost of Medicaid benefits.

They also point out that capping federal Medicaid support will apply per person, so if there’s an influx of new enrollees because of an economic downturn, it would not result in a dramatic reduction in resources for people in the program.

But while McConnell has sought to win over conservatives with a stricter index for Medicaid inflation adjustments, he has stayed away from their demand to gut one of ObamaCare’s popular insurance reforms.

Lee, Sen. Ted Cruz (R-Texas) and other conservatives have pushed the GOP leader to allow states to exempt themselves from the so-called community rating regulation that requires insurance companies to offer health plans to people at the same price, regardless of what pre-existing medical conditions they have.

“They’re not in any way touching community rating,” grumbled a Senate source familiar with the negotiations.