GOP votes slip away on health care bill

The latest effort to repeal the 2010 health care law known as Obamacare doesn’t appear to have the 51 Republican votes needed to pass, but among those offering cautious praise Monday was Sen. Rob Portman.

Portman, R-Ohio, who has fought – so far unsuccessfully – to get more money for opioid treatment in the bill sponsored by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana – nonetheless complimented the bill in a Senate Finance Committee hearing on the measure Monday. Though he acknowledged having concerns about the formula, Portman praised the bill’s plan to allow states to craft their own insurance plans. 

“This is a very different proposal than the proposals we were looking at previously,” he said. “It takes the funding in the Affordable Care Act and sends it back to the states and gives states flexibility to be able to do what they think is right for its citizens.”

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Portman argued the measure – which has faced intense opposition from health care groups including the American Medical Association, the American Hospital Association and the BlueCross BlueShield Association – has been “mischaracterized,” but said “the status quo is not working.” 

Two GOP senators – John McCain of Arizona and Rand Paul of Kentucky – have already said they will vote against the bill, while three other senators have said they are leaning no. Portman has not indicated how he will vote on the bill, and staff say he is still pushing for opioid funding to be included in the bill.

But offering far harsher criticism of the bill Monday was Sen. Sherrod Brown, who, like all Senate Democrats, opposes the bill. He said the bill’s plan to turn federal dollars into block grants does not suffice in treating the epidemic, and asked witnesses whether more would die without the Medicaid funding that states have relied on to treat the epidemic.

“I’m concerned they will,” said acting Pennsylvania Human Services Secretary Teresa Miller. “With the reduced funding, governors are going to have to make very difficult decisions and some of those decisions may be eliminating essential health benefits like substance abuse treatment.”

Defending his bill, Graham suggested that the Senate had little choice but to act.

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“If somebody doesn’t fix Obamacare soon, a majority of the counties in the country are going to be down to one provider,” he said, adding that Medicare and Medicaid are also becoming rapidly unsustainable, and on track to cost more than the military by 2027 and on track to take up all taxpayer dollars by 2042.

The bill would largely retain the taxes that paid for the 2010 health care law known as Obamacare but would end within three years the Medicaid expansion that states such as Ohio accepted. Instead, the federal government would give states per-capita grants, which might not be enough to pay for the previously expanded programs.

The bill would also repeal the 2010 law’s requirement that individuals buy federally subsidized insurance policies set up through the states and the federal government.

Republicans have until Sept. 30 to pass legislation under a budget procedure that allows the Senate to pass bills with a 51-vote majority, rather than the 60 vote threshold that many Senate bills require. The Senate has 52 Republicans and 48 Democrats. 

Ohio Gov. John Kasich has earlier pushed for the Senate to pursue a bipartisan effort by Democrat Patty Murray of Washington and Republican Lamar Alexander of Tennessee to shore up the insurance markets. But their efforts broke down after Senate GOP leadership indicated they would push the Graham-Cassidy bill last week, and the House GOP leadership has been cool about the idea of taking up any solution hammered out by Murray and Alexander.

Former Sen. Rick Santorum, also testifying in support of the bill, said much of the opposition to it has been “hysteria.” 

But Miller said the Graham-Cassidy plan "would create chaos in our health care system with frightening implications" by stripping funding that states have come to rely upon.

"There are no winners in this bill, but many who will lose, and many who will be at grave risk," she said, urging the committee, “Please do not paper over spending cuts and diminishment of consumer protections using the guise of state flexibility.” 

The hearing looked, for a moment as if it would not happen. Senate Finance Committee Chairman Orrin Hatch, R-Utah, put the hearing into recess after about a dozen protesters, many in wheelchairs, began chanting “No cuts for Medicaid, save our liberty.” 

“If you want a hearing you’d better shut up,” Hatch said, before gaveling the hearing into recess. Capitol police dragged protester after protester out of the hearing room, occasionally grunting from the effort of physically lifting some protesters. 

Kasich and Democrats have insisted that the process has been far too rushed, with only one hearing to examine the bill’s provisions. And multiple analyses of the bill indicate that it would cost Ohio anywhere from hundreds of millions to billions in federal dollars.

“Nobody has got to buy a lemon just because it’s the last car on the lot,” said Sen. Ron Wyden of Oregon, the ranking Democrat on the committee. “The fact that it’s the last repeal bill standing doesn’t make it okay.”

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