To pass the GOP-written health care bill, Majority Leader Mitch McConnell must first resolve the clashing demands within his party while dealing with the wall of opposition coming from the Democratic party.
Senate Republicans Divided over the Healthcare Bill
The GOP will not be able to pass its health care overhaul aka Trumpcare in Senate if just three out of their 52 Senators choose to defect. What’s more, a damaging report from the Congressional Budget Office revealed that the bill in its current form would create 23 million extra uninsured people over the next decade, while boosting premiums for the older and sicker patients to unaffordable levels.
Republican senators are scrambling to craft a more inclusive health care reform bill, but first, McConnell must solve a plethora of problems. To start, most Republican senators oppose the idea of leaving 23 million Americans without health insurance. The move would take a heavy toll on their political careers.
In 2018, the GOP will only have to secure fewer than a dozen of the 34 seats in the Senate race to maintain their majority. Republicans up for reelection worry that those hit hardest by the changes to their insurance coverage will push back the strongest at the voting booth.
To reduce the number of people losing health insurance, the GOP will need to boost funding for Medicaid, increase federal subsidies and extend tax credits; all of which goes against their nature.
Medicaid a Huge Problem
One major obstacle is how to handle Medicaid. The AHCA, which cleared the House earlier this month, would halt the Medicaid expansion in 31 states in three years’ time. The new bill would provide states with fixed annual sums of money instead. The current program is open-ended to compensate states for their additional financial burden under expanded Medicaid.
The measures will translate into $834 billion in cuts in the coming ten years, which would force around 14 million people (17%) out of eligibility. This represents a problem for Republicans whose states they represent heavily rely on Medicaid.
Most of the nearly 20 Republican senators from those states oppose the GOP’s leadership plan to end the additional federal payments. Those senators will likely want a compromise such as phasing out the extra payments over additional years.
Those Senators may seek to increase the fixed-payment amounts more than the GOP has originally proposed and to protect federal funds given to states to fight the opioid abuse epidemic as well.
By contrast, conservatives within the GOP plan to slash all Medicaid funding. They want to phase out the extra payments over a decade, but the process would begin as early as next year.
Other conservatives including Sen. Ted Cruz want to dismantle certain Obama-era requirements like forcing insurance companies to set the same premiums for sick individuals or people with pre-existing conditions that they do for healthy ones.
Moderates are concerned that setting higher premiums for people with pre-existing conditions would give Democrats a popularity boost. Conservatives respond to moderates’ concerns by saying that people would still have access to affordable healthcare despite sacrificing a more robust coverage.
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