jueves, 29 de junio de 2017

GOP scrambles to win centrist votes on ObamaCare repeal

Senate Republican leaders are focused on winning over centrists as they try to revive their legislation repealing and replacing ObamaCare.

Their strategy is to win over moderates who balked at their earlier bill, and then hope that the pressure to take action on the GOP’s promise to repeal former President Obama’s signature legislation will be enough to get conservative senators to back the bill.

GOP leaders can only afford to lose two votes, giving them little room for error.The most notable sign of their strategy on Thursday was a willingness to scrap cutting the capital gains tax rate on wealthy individuals and families from 23.8 percent to 20 percent, according to several GOP senators.

GOP leaders would use the savings to provide more money for low-income Americans who might not be able to afford health insurance — a goal of centrist Republican opponents of the healthcare bill.

“Leaving the burden on the low-income and at the same time repealing that 3.8 percent is not an appropriate way going about dealing with this issue and leadership is attempting to address that. I'm actually very confident that's going to be addressed,” Sen. Bob Corker (R-Tenn.) told reporters Thursday afternoon.

Scrapping language cutting the capital gains tax would provide hundreds of billions of dollars in additional revenue to increase tax credits for low-income families, beef up the stabilization fund and enhance Medicaid payments.

Many Republican senators said they are open to the change, but some conservatives objected.

“We pledged that we would repeal ObamaCare,” Sen. Pat Toomey (R-Pa.) told reporters. “I don't remember anybody going around saying, 'Oh except for these job killing tax increases.’”

Sen. John Thune (R-S.D.) said keeping the tax is under consideration, as is boosting up the generosity of the tax credits.

Republican leaders have also indicated a willingness to dramatically increase a $62 billion fund that would help low-income individuals with high healthcare costs buy insurance.

One Republican senator said the fund could as much as double. A GOP aide said leaders would “pour a lot of money” into it to alleviate concerns among moderate lawmakers.

Senate Republican Whip John Cornyn (Texas) cast the fund as giving more power to states.

“That’s going to be an important part of this,” said Cornyn, the No. 2 Republican. “What it represents is a devolution of power and money from Washington back to the states. So the states are going to have a lot of resources and a lot of flexibility.

Another change aimed at centrists would add $45 billion to the bill to fight opioid abuse. Sens. Shelley Moore Capito (R-W.Va.) and Rob Portman (R-Ohio) both praised that change, though the two senators worried about Medicaid cuts are not ready to support the bill yet.

“I’m not there yet, I know that,” Capito said.

Senate Majority Leader Mitch McConnell (R-Ky.) had to drop plans for a vote this week after five GOP colleagues threatened to block a procedural vote on the measure.

McConnell’s new goal is to get a deal by Friday that would allow the Congressional Budget Office to produced a new score over the recess. The Senate might then vote for the legislation when it returns from recess.

Some Republican senators are worried the bill as currently drafted could become a millstone around the party’s neck, sinking it in future elections.

Sen. Lindsey Graham (R-S.C.), speaking at the Senate Republican lunch Thursday, told colleagues that while he understands the party has made a promise to repeal ObamaCare, that doesn’t mean they should rush through flawed legislation.

He warned colleagues in the private meeting, “just because we made a promise doesn’t mean we have to pass a bad product,” according to one source who attended the private meeting.

Another source recalled Graham warning that colleagues shouldn’t pass an “unpopular” bill, arguing if the rationale is to fulfill a political promise, colleagues should think about whether the outcome is politically intelligent.

A new NPR/PBS Newshour/Marist poll released Wednesday showed that only one in five people approve of the Senate bill and only 35 percent of Republicans like it.

In another nod to centrists, Republicans are talking about using the House formula for indexing the growth of Medicaid, which would make the bill more expensive but lower cuts to the program.

Moderates have pointed out that the change would only add $12 billion to the bill’s costs.

But changing the formula would risk the support of Toomey, who has led the charge to curb Medicaid’s future growth.

Centrists are also pushing for a longer glide path for phasing out federal dollars that allowed 31 states to expand Medicaid.

The current draft would begin to scale down the federal portion beginning in 2021 and spread the phase-out over three years. Moderates want a five-year phase-out instead.

An additional 14 million people have signed up for Medicaid under Obama’s expanded guidelines.

On the conservative side, Cruz and Sen. Mike Lee (Utah) are pushing for a change that would allow insurers to sell plans that did not meet ObamaCare's regulations if they also sold plans that did.

They met with GOP leaders and the Senate parliamentarian on Thursday morning to discuss whether the change would be allowed under Senate rules.

One Senate aide said Cruz is telling colleague that “pre-existing conditions is my line in the sand,” threatening to sink the bill if it doesn’t repeal regulation requiring companies to sell affordable health insurance to people regardless of what illnesses they may have.

But there are serious policy concerns among much of the rest of the conference, which is worried that the change would mean insurers could sell plans without protections for people with pre-existing conditions.

McConnell told Republican senators at a private meeting earlier this month that he would “not touch pre-existing conditions” in the bill, the GOP aide noted.

Cruz did not raise a serious objection when the conference was informed of that leadership position, according to the aide.

Many Republican lawmakers are concerned that healthy people would flock to the cheaper plans without ObamaCare protections, while only sicker people would be left in the plans that remained under the ObamaCare regulations, driving up costs among that pool of people.

Thune said Cruz’s change “could” be included, but “it has to be structured in a way that ensures that the pools aren't adversely affected.”

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