Conservatives push back on Senate changes to health bill

Conservatives are pushing back strongly against the Senate’s proposed changes to the House healthcare reform bill, fearing the legislation is moving in the wrong direction. 

Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.Va.) — some of the chamber’s more centrist members — have proposed gradually phasing out extra federal funds for Medicaid over seven years, beginning in 2020. That is longer than a House GOP leadership proposal to eliminate Medicaid expansion funding by 2023. 

But there’s the conservative wing to contend with, and a conservative Senate aide called both plans for Medicaid “terrible ideas.” 

{mosads}“These provisions will make it difficult for conservative senators to vote for the bill,” the aide wrote in an email. 

Conservatives are also concerned that the Senate bill is poised to allow states to be granted waivers for the ObamaCare rules on what insurance plans must cover, known as essential health benefits, but not the rules preventing people with pre-existing conditions being charged more. That would be a departure from the House bill, which conservatives say they already compromised on.   

“There has to be a give and take, and right now it seems like conservatives are being told just to take it all and not get anything,” said Dan Holler, a spokesman for Heritage Action for America, a conservative group. 

Jason Pye, director of legislative affairs for the conservative group FreedomWorks, sounded a similar note. 

“There’s a lot of things I’m hearing that are concerning,” he said. “I’ve heard very few things that are positive.” 

He called the slower Medicaid phase-out proposal “a concern,” as well as the absence of waivers for pre-existing conditions.   

There is also a divide among Republicans over how fast a cap on Medicaid payments should grow. Conservatives are pushing for slower growth than what’s in the House bill, meaning deeper reductions in Medicaid spending. 

But more centrist members are pushing back. Sen. Dean Heller (R-Nev.) said Thursday that he does not want the cap to Medicaid spending to be any more that what is already in the House bill.

Heller — who is up for reelection in 2018 — also said he opposes waivers for states to repeal both the Essential Health Benefits and community rating, illustrating the divide on that issue.   

Medicaid has become one of the trickiest issues in the healthcare debate.

Under ObamaCare, states have the option of accepting an expansion of Medicaid that allows them to cover more low-income people. The federal government picks up most of the tab.

Senators representing states that took the Medicaid expansion under ObamaCare want to ensure their constituents don’t lose coverage, while other senators don’t want their states to be penalized for toeing the original party line and rejecting the expansion. 

The Congressional Budget Office estimated that the House bill would result in 14 million fewer people on Medicaid by 2026. 

Republicans have a slim 52-48 Senate majority, giving them little margin for error in a vote to repeal and replace ObamaCare. 

The emerging dynamic in the Senate is similar to the one that caused problems for leaders in the House. Move the bill to the right, and more centrist senators will object. Move it more to the center, and the conservative factions will turn against it. 

The House bill didn’t gradually phase out enhanced federal funds for the Medicaid expansion; rather, the legislation cut the money off in 2020. Several moderate House members cited Medicaid as one of the reasons why they ultimately voted against the American Health Care Act.