- The Washington Times - Monday, June 26, 2017

Senate Republicans released a revised version of their health care plan Monday, replacing Obamacare’s “individual mandate” with a provision designed to prevent Americans from waiting until they get sick to sign up for insurance coverage.

The updated draft would require consumers who had a break in coverage for 63 days or more in the prior year to wait six months before their insurance takes effect. It’s a twist on the House bill, which would have allowed insurers to tack on a surcharge after long lapses in coverage.

Republicans say the provision, which begins in 2019, is needed to make sure people don’t “game the system” by waiting to enroll in a plan right before they submit costly medical claims, rather than paying premiums over time.

Insurers pushed for the provision because Republicans want to scrap penalties tied to President Obama’s unpopular mandate, which forces people to get coverage or pay a tax.

While insurers reviewed the proposal, Democrats faulted it outright, saying it would penalize people who lose their jobs, fall on hard times or otherwise lose coverage through no fault of their own.

“The Senate Republicans’ latest version of Trumpcare would pour salt in that wound, locking American families out of health insurance for even longer thanks to this six-month ban provision,” said Senate Minority Leader Charles E. Schumer, New York Democrat.

Senate Majority Leader Mitch McConnell, Kentucky Republican, is using fast-track budget rules to carve Democrats out of the repeal process, so restive holdouts in his own conference are his main worry ahead of a planned vote this week

He cannot afford to lose more than two members of his 52-seat majority and still pass a plan.

Yet five Senate Republicans have said they won’t vote for the bill in its current form — four conservatives who say the legislation doesn’t fix Obamacare’s flaws and drive down premiums, and Sen. Dean Heller, Nevada Republican, who is vulnerable in next year’s election cycle and says the bill is too tough on Medicaid coverage for the poor.

Sen. Ron Johnson, Wisconsin Republican, was unusually blunt during a radio interview with Hugh Hewitt, saying party leaders were trying to jam the legislation through the chamber before senators could vet it or make useful changes.

Senate Majority Whip John Cornyn, Texas Republican, made it clear on Monday that he isn’t interested in letting the floor fight slip beyond this week.

“I am closing the door. We need to do it this week before double-digit premium increases are announced for next year,” he said on Twitter, responding to news reports that he left the door open to a delay through Aug. 1.

Also Monday, the Congressional Budget Office is expected to release its budget analysis, or “score,” of how the draft legislation will impact federal spending and coverage.

The bill’s drafters expect the score to reflect the latest changes, according to an aide.

Republicans and President Trump’s health secretary have tried to downplay the CBO’s ability to estimate the effects of their bill. They say the figures are dependent on future behavior, such as how many people choose to forgo insurance because they would no longer be penalized.

“The CBO does a great job, by and large, on how much something costs — budget, that’s what they do well,” Health and Human Services Secretary Tom Price said Sunday. “They do a relatively poor job on what the coverage consequences of a health plan are.”

Still, the CBO’s findings should guide Republican senators who are trying to decide whether they can back the plan ahead of a planned vote this week.

“I want to wait to see the CBO analysis. But I have very serious concerns about the bill,” Sen. Susan M. Collins, Maine Republican and notable holdout, said Sunday on ABC News.

As written, the draft bill repeals most of Obamacare’s taxes and penalties tied to its individual mandate, replaces its generous subsidies with refundable, age-based tax credits and reins in and caps spending on the Medicaid program for the poor. It also strips Planned Parenthood of federal funding as punishment for its abortion practice

Unlike the House bill, the Senate plan scales down funding for states that embraced Mr. Obama’s vast expansion of Medicaid for the poor through 2024, rather than freezing it in 2020.

It also provided more generous tax credits to poorer and older Americans who could struggle to afford coverage under the House plan.

Yet to placate fiscal hawks, the plan would allow Medicaid spending to rise at a slower rate than in the House version, starting in 2025.

The American Medical Association blasted the plan Monday for cutting Medicaid spending, allowing insurers to offer skimpier coverage and replacing Obamacare’s subsidies with less generous tax credits, citing the doctor’s oath to “first, do no harm.”

“The draft legislation violates that standard on many levels,” AMA CEO James L. Madara said.

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