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Former Member

What’s Dividing Republican Senators on the Health Care Bill

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As Republican leaders plan to release a revised health care bill on Thursday, at least a dozen senators have expressed concerns about several major issues in the current draft.

Pre-Existing Conditions and Other Regulations

The current draft of the Senate bill preserves the Affordable Care Act’s protection for people with pre-existing illnesses. However, it allows states to waive many other rules, including the requirement that insurers cover a basic set of benefits. Senators Ted Cruz and Mike Lee want to add an amendment that would allow insurers to offer plans that do not follow any of the Affordable Care Act’s rules.

Want fewer regulations

 

Portrait:
Ted Cruz Tex.
Said his amendment would lower premiums and give consumers freedom “without the government mandates.”
Portrait:
Ron Johnson Wis.
Wrote an op-ed calling for the loosening of regulations and mandates.
Portrait:
Mike Lee Utah
Backs Mr. Cruz's amendment, saying that consumers would have less-expensive options.
Portrait:
Rand Paul Ky.
Said that “you have to repeal the regulations if you want to bring down prices for people.”
 
 

Emphasize keeping protections

 

Portrait:
Shelley Moore Capito W.Va.
Said Mr. Cruz's amendment “would make it too difficult for people with pre-existing conditions to get coverage.”
Portrait:
Bill Cassidy La.
Said in May that any bill needs to pass the “Jimmy Kimmel test,” meaning that “a child born with congenital heart disease be able to get everything she or he would need in that first year of life.”
Portrait:
Susan Collins Me.
Said Mr. Cruz's amendment “would erode protections for people with pre-existing conditions.”
Portrait:
Charles E. Grassley Iowa
Said he would object to Mr. Cruz's amendment if it “has the effect of annihilating the pre-existing condition requirement” in the existing bill.
Portrait:
Dean Heller Nev.
Said the bill does not do enough to “protect Nevadans with pre-existing conditions.”

Replies sorted oldest to newest

Medicaid Funding

Many senators represent states that, under the Affordable Care Act, expanded Medicaid to cover more people, and they are worried that the Senate bill’s funding reductions would require states to cut benefits and enrollees. But major changes to the Medicaid provisions in the bill are not likely.

From state that expanded Medicaid

 

Portrait:
Shelley Moore Capito W.Va.
Said the bill “cuts traditional Medicaid too deeply.”
Portrait:
Dean Heller Nev.
“I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid.”
Portrait:
John Hoeven N.D.
Said he is “especially concerned by the C.B.O.’s analysis of the bill’s impact on Medicaid.”
Portrait:
John McCain Ariz.
“My own governor is extremely worried, because we’re a Medicaid expansion state and we would lose a whole lot of money, according to him.”
Portrait:
Lisa Murkowski Alaska
Said in February that as long as the Alaska Legislature wants to keep the Medicaid expansion, “I will not vote to repeal it.”
Portrait:
Rob Portman Ohio
“I continue to have real concerns about the Medicaid policies.”
 

From non-expansion state

 

Portrait:
Jerry Moran Kan.
“It takes money out of a state that didn't expand Medicaid and provides it to states that did expand Medicaid.”
Portrait:
Susan Collins Me.
“Medicaid cuts hurt most vulnerable Americans.”
FM

Subsidies for Insurance Premiums

Some of the more moderate Republican senators are worried that the bill cuts government subsidies too much, particularly for older Americans. The more conservative bloc wants to further reduce the subsidies.

Want more tax credits

 

Portrait:
Susan Collins Me.
“I’m very concerned about the cost of insurance for older people.”
Portrait:
Bob Corker Tenn.
Said that lower-income people should “have the ability to actually purchase plans that give them health care.”
Portrait:
Michael Rounds S.D.
Has proposed expanding tax credits to people currently ineligible for their spouse's employer-based plan.
 

Want less government spending

 

Portrait:
Ron Johnson Wis.
Wrote an op-ed calling for a reduction in “the cost of taxpayer subsidies,” saying that the Senate bill "relies too heavily on government spending."
Portrait:
Rand Paul Ky.
Said that the bill “simply proposes to modify and extend” the Affordable Care Act's premium tax credits that Republicans voted to eliminate in 2015.
FM

Affordable Care Act Taxes

The current version of the bill repeals a 3.8 percent tax on investment income and a 0.9 percent payroll tax for high-income households, a change that would result in a large tax cut for the wealthiest Americans. Republicans have discussed keeping the taxes, a move that could help pay for insurance subsidies, and it is likely they will remain.

 

Portrait:
Susan Collins Me.
“I do not see a justification for doing away with the 3.8 percent tax.”
Portrait:
Bob Corker Tenn.
Said it's not acceptable “to have a bill that increases the burden on lower-income citizens and lessens the burden on wealthy citizens.”
Portrait:
Michael Rounds S.D.
“I think we ought to take a look at the investment tax that's in the system now and whether or not it would be appropriate to allow that tax to remain.”
FM

Fighting the Opioid Crisis

Republican senators in states particularly affected by the opioid drug crisis have expressed concerns about cuts to Medicaid and have pushed to add more funding to fight the problem. The current version of the bill provides $2 billion in federal grants to states next year, while the revised bill is expected to include a $45 billion fund.

 

Portrait:
Shelley Moore Capito W.Va.
Said the bill “does not do enough to combat the opioid epidemic that is devastating my state.”
Portrait:
Rob Portman Ohio
Said he has concerns about Medicaid policies, “especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic.”
FM

Funding Planned Parenthood

Two female Republican senators oppose a provision in the bill that cuts off federal funding from Planned Parenthood, saying that the organization provides crucial services to women in their states. The current version removes the funding for one year.

 

Portrait:
Susan Collins Me.
“It makes absolutely no sense to eliminate federal funding for Planned Parenthood.”
Portrait:
Lisa Murkowski Alaska
“I will fight to keep the funding in” for Planned Parenthood.
FM

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