(Bloomberg) — Senate leaders released a slightly revised version of the Better Care Reconciliation Act, their health care bill, Monday as Senate Majority Leader Mitch McConnell tries to win over enough holdouts to pass the measure, with at least six Republicans signaling opposition.
The most significant change in the BCRA bill is the inclusion of a new provision to encourage Americans to maintain continuous health care coverage that would replace the Affordable Care Act individual mandate. The new provision would impose a six-month waiting period before new insurance goes into effect for anyone who had a break in coverage lasting 63 days or longer in the prior year. It would take effect beginning in 2019.
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A number of Republican senators are still demanding a variety of changes in what is shaping up as McConnell’s toughest test as Senate majority leader.
McConnell can only afford two defections and still pass his Affordable Care Act change legislation, but Republicans only saw McConnell’s draft bill for the first time Thursday. With both moderates and conservatives expressing deep concern about McConnell’s “discussion draft,” he faces a narrow path to passage.
Defeat may scuttle plans to make big changes to the Affordable Care Act for the foreseeable future.
“It will hurt the Republicans if they fumble on the issue that has been their signature issue,” said Julian Zelizer, a historian at Princeton University. “That won’t look good if they can’t do this. This is a high-stakes moment.”
And for McConnell, it will show whether he can move beyond his reputation as an obstructionist and deliver on his party’s biggest priorities.
The health care measure could dramatically affect many Americans’ health and financial security while also posing challenges to state governments facing proposed cuts in Medicaid coverage for low-income residents.
The American Medical Association, the biggest lobby group for U.S. doctors, on Monday said it opposes the Senate’s health bill. The AMA said the bill would “expose low-and middle-income patients to higher costs and greater difficulty in affording care,” while calling the cuts to Medicaid a “serious mistake.”
McConnell’s challenge is similar to the one Speaker Paul Ryan faced when the House passed its own plan in May — conservative and moderate GOP wings balking at different parts — but with a much smaller margin of error to pass his version of the plan, H.R. 1628. With 50 votes, a tie-breaker by Vice President Mike Pence would ensure passage.
Nevada Sen. Dean Heller said Friday he’ll oppose the bill in its current form largely because of its cuts to Medicaid and to subsidies for individual insurance coverage. Heller, the Senate Republican seen as most at risk in the 2018 midterm election, also said he’s likely to vote with Democrats to block it from floor consideration.
On Sunday’s television talk shows, two other moderates — Susan Collins of Maine and Bill Cassidy of Louisiana — said they can’t say yet how they’ll vote and expressed reservations about McConnell’s speedy deadline for action.
Collins said she’s “very concerned” about the bill’s impact on Medicaid coverage for the sickest people. She also opposes its one-year ban on funding for Planned Parenthood, a provision she wants to strike on the Senate floor.
“It’s hard for me to see the bill passing this week, but that’s up to the majority leader,” Collins said on ABC’s “This Week.”
Conversely, four conservatives — Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah and Ron Johnson of Wisconsin — say the plan keeps too much of the Affordable Care Act. They announced they’ll need a number of changes before they’ll back it, and Johnson said Sunday the rushed process could cause him to join Heller in voting to block the start of debate.
“I have a hard time believing Wisconsin constituents, or even myself, will have enough time to properly evaluate this for me to vote for the motion to proceed,” he said on NBC’s “Meet the Press.”
The Congressional Budget Office will issue an analysis as early as Monday spelling out how many Americans may lose health insurance under the bill and whether it contains enough financial wiggle room to let McConnell try to woo holdout senators with increased funds.
The CBO said the House version, which includes $834 billion in Medicaid cuts and $664 billion in tax cuts, would cause 23 million Americans to lose their health insurance by 2026. A reduction in the number of people losing insurance under the Senate bill might bolster support for it.