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Less than 24 hours from now, Senate Republicans will unveil their plan to repeal and replace Obamacare.
With just hours to go, many Republican senators say they know little about what will be in the plan — and that it's still being tweaked.
"They’re still drafting and hope to have it, [from] what they tell us, to us tomorrow and then they’ll release it publicly," Sen. John Hoeven (R-ND) told Vox's Dylan Scott.
"We don’t have the text yet," Senate Majority Whip John Cornyn told Dylan. "But we’re gonna get there."
BuzzFeed's Paul McLeod asked Sen. Bill Cassidy (R-LA) about an important and specific provision in the bill, whether it would allow states to waive out of the Affordable Care Act's essential health benefits requirement. Here's what he got back:
Asked if health bill will let states waive essential health benefits, Sen. Bill Cassidy says it's "under discussion." Bill release in 20 hrs
— Paul McLeod (@pdmcleod) June 21, 2017
This suggests one of two things:
- Senate leadership is holding the bill very close to the vest, and these senators really don't know what is in the bill. They'll be reading it for the first time tomorrow, with the rest of us.
- Senators do know what’s in the bill but don't want to discuss it.
Neither says great things about the state of health care negotiations. If lots of senators really are in the dark on the health care bill, it means that leadership will need to do a lot of convincing, cajoling, and bargaining over the next week in order to get the 50 votes necessary to pass it.
But the second scenario isn't that great either. One thing that jumps out in these interviews is that senators aren't rushing to defend this bill on its policy merits. Most discussions about policy revolve around things Republican senators don't like — like Sen. Susan Collins of Maine, who has voiced concern about Medicaid cuts, or Sen. Rand Paul of Kentucky, who has told lots of reporters that he's concerned the bill keeps too much of Obamacare in place.
As my colleagues found when they asked eight Republican senators why this bill needs to pass, it's difficult to get a policy defense.
It is easier to dodge questions about a health care bill when you can say it's private and you haven't read it. It will become a whole lot harder to do this tomorrow when the bill becomes public.
Anthem says goodbye to Obamacare marketplaces; Oscar says hello
Insurers faced a deadline today to decide whether they will sell coverage on the Obamacare marketplaces. We're still seeing announcements trickle in, but a few stand out:
- Anthem will quit Obamacare in Wisconsin and Indiana. The health plan already exited Ohio and has now announced two additional states it will leave in the face of growing uncertainty. "While we are pleased that some steps have been taken to address the long-term challenges all health plans serving the Individual market are facing, the Individual market remains volatile," the health plan said in a statement.
Oscar will expand into five more states. The health insurance startup is the rare health plan that is bullish on the marketplace's future. It will continue to sell in New York in 2018 and expand to parts of California, New Jersey, Ohio, Tennessee, and Texas. Oscar was co-founded by Josh Kushner, who happens to be the brother of senior Trump adviser Jared Kushner.
Photo of the Day
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The littlest lobbyist: A 6-year-old whose life depends on ACA heads to Capitol Hill. I spent yesterday following Timmy Morrison, a young boy who has benefited from the Affordable Care Act's ban on lifetime limits. His parents took him to Capitol Hill to lobby senators on the issue. While they waited for a meeting with Sen. Chuck Schumer (D-NY), Timmy's little sister Ivy took a short nap on the senator's couch. Read the full story here.
Kliff’s Notes
Your daily top health care reads, with research help from Caitlin Davis
Today's top news
- "GOP Might Buck Senate Rules to Pass Health Care Overhaul": “GOP leaders are sending signals that, if necessary, they plan to invoke a seldom-used rule included in the Congressional Budget Act that would allow Senate Budget Chairman Michael B. Enzi to skirt a decision from the chamber’s parliamentarian, a key gate-keeper for the budget maneuver known as reconciliation that Republicans are using to advance their health insurance measure.” —Joe Williams, Roll Call
- "G.O.P. Rift Over Medicaid and Opioids Imperils Senate Health Bill": "Republican senators from states that have been hit hard by the opioid drug crisis have tried to cushion the Medicaid blow with a separate funding stream of $45 billion over 10 years for substance abuse treatment and prevention costs, now covered by the expansion of Medicaid under the Affordable Care Act. But that, too, is running into opposition from conservatives. They have been tussling over the issue with moderate Republican senators like Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Susan Collins of Maine." —Robert Pear and Jennifer Steinhauer, New York Times
- "White House launches ACA repeal website": “The White House is giving a push to the Senate health care bill with a new website highlighting the Trump administration's arguments for repealing the Affordable Care Act. It features a video outlining the problems it sees with the law — skyrocketing individual insurance premiums, insurers leaving the marketplaces — and statistics about the lack of competition and people who have paid penalties rather than buying health coverage.” —David Nather, Axios
- "Trump Administration Makes ACA Payments to Health Insurers for June": "The Trump administration made contested payments to health insurers for the month of June, removing the possibility of an abrupt cutoff just as many insurers make decisions about coverage under the Affordable Care Act in 2018. The fate of 'cost-sharing reduction' payments, which reimburse health plans for lowering copays and deductibles for millions of low-income people who get coverage under the 2010 law, often dubbed Obamacare, has been a running backdrop in the debate over Republicans’ bid to scrap that law." —Louise Radnofsky, Wall Street Journal
Analysis and longer reads
- "How McConnell gets to 50 votes to repeal Obamacare": “Senate Majority Leader Mitch McConnell needs to nail down 50 GOP votes to repeal Obamacare. He has no easy options. He can lean toward conservatives like Rand Paul of Kentucky and Mike Lee of Utah, who want to dismantle as much of Obamacare as they possibly can. But if he does that, he risks losing a group of Senate moderates, including Susan Collins of Maine, Lisa Murkowski of Alaska, Rob Portman of Ohio and Shelley Moore Capito of West Virginia, who are pushing for a slower phase-out of the Medicaid expansion that is covering low-income people in some of their states.” —Jennifer Haberkorn, Politico
- "G.O.P. Health Plan Is Really a Rollback of Medicaid": “'While details remain elusive, this is shaping up to be the largest intergovernmental transfer of financial risk in our country’s history,' said Matt Salo, the executive director of the National Association of Medicaid Directors, in an email. Mr. Salo said that some of his directors would welcome caps if they came with more program flexibility, but said the current approach amounted to a funding cut.” —Margot Sanger-Katz, New York Times
- "One Almost-Certain Risk for Investors in the Health-Care Bill": “The Centers for Medicare and Medicaid Service estimated that the House bill would increase total out of pocket spending by $221 billion more than the current law over 10 years. Those increased out of pocket costs will make Americans more aware of how much they pay for health care. That could be especially pronounced for consumers buying individual plans on public exchanges.” —Charley Grant, Wall Street Journal
- "CEOs Say They'll Sell Health Insurance Next Year, But Are Flying Blind": “Wednesday is a deadline of sorts for these companies. If they want to sell policies next year in states that use the federal health exchange on Healthcare.gov, they have to let Health and Human Services know their intentions. How are they dealing? I reached out to a couple of insurance executives and asked.” —Alison Kodjak, NPR
- "Republicans see Medicaid as welfare. Most Americans don't": “Republicans want to roll back the Medicaid expansion, cap federal Medicaid spending increases, and add work requirements, drug testing, time limits, copays and premiums to some state Medicaid programs. But almost no one else wants to do these things. One poll finding goes a long way toward explaining why: Republicans view Medicaid as a form of welfare, and pretty much everyone else views it as a government insurance program.” —Drew Altman, Axios
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