McConnell juggles diverse demands on GOP health bill

Associated Press

WASHINGTON

For Majority Leader Mitch McConnell, writing a Republican-only health care bill that can pass the Senate boils down to this question: How do you solve a problem like Dean, Lisa, Patrick, Ted, Rand and Susan?

Those are some GOP senators whose clashing demands McConnell, R-Ky., must resolve. Facing solid Democratic opposition to demolishing former President Barack Obama’s 2010 overhaul, Republicans will lose if just three of their 52 senators defect.

In a report that complicated McConnell’s task, the nonpartisan Congressional Budget Office delivered a damaging critique last week of the GOP-written bill the House approved May 4. It concluded the measure would create 23 million additional uninsured Americans by 2026; lower premiums for younger and healthy people by letting them buy sparser coverage; and confront unhealthy, poorer and older consumers with exorbitant out-of-pocket costs.

As GOP senators try privately crafting a bill, here are some problems facing McConnell:

23 MILLION!?!?

Booting that many people off health coverage is a nonstarter for many Republican senators. It’s a campaign attack ad that writes itself.

Republicans defend just nine of the 34 seats on next year’s Senate election map.

Most losing coverage would be Medicaid beneficiaries. Also hurt are people buying their own insurance and others getting coverage at work.

The number can be reduced by spending more on Medicaid, fattening tax credits for people buying insurance and boosting government payments to insurers to help them lower consumers’ costs.

Those steps are complicated and expensive.

MEDICAID

The House bill would halt extra federal funds in 2020 that 31 states get for Obama’s expansion of the federal-state health care program for poorer and disabled Americans. The legislation would also give states fixed federal sums annually, ending the open-ended payments Washington has always made to reflect growing medical expenses and caseloads.

This means an $834 billion cut over the coming decade that would produce 14 million, or 17 percent, fewer Medicaid beneficiaries than projected, the budget office said. This is a problem for Republicans from states with a heavy reliance on Medicaid.

Twenty GOP senators are from states that expanded Medicaid, and most oppose abruptly ending the Obama law’s extra federal payments. They include moderates like Sen. Rob Portman of Ohio, whose state Medicaid program has added 700,000 enrollees; as well as Alaska’s Lisa Murkowski, Shelley Moore Capito of West Virginia and Heller.

These senators are seeking a compromise that would phase out the extra federal expansion money for several additional years.

CONSERVATIVES

Many conservatives want to curb Medicaid spending. In one proposal, they’d phase out extra federal Medicaid expansion money over a decade but reductions would begin next year.

Sen. Patrick Toomey’s Pennsylvania has expanded Medicaid, but he’s also one of the Senate’s more conservative members. He’s seeking compromise with Portman on curtailing Medicaid, saying it “must be on a sustainable path.”