Freshman U.S. Sen. Todd Young, R-Indiana, articulated this month what should be a no-brainer: The looming health care reform legislation should be a bipartisan effort. Young wrote to the 48 members of the Senate Democratic caucus, “If we are going to achieve lasting results, we need to reach bipartisan conclusions. I firmly believe the best solution possible can be reached by working together. As this debate advances, give me a call; I would be happy to grab a cup of coffee and hear your thoughts and ideas.”
He found partial agreement with Democratic Sen. Joe Donnelly, who said on the Senate floor Monday, “Indiana and our country would be better off if we could work together to produce bipartisan legislation rather than a partisan bill drafted in secret and voted on without input or a single Senate hearing.”
Where Donnelly parts with Young is his belief that President Donald Trump and congressional Republicans purposely blew up Obamacare instead of working over the past seven years to evolve the law. In his view, this has accelerated under Trump.
On Wednesday, we learned Indianapolis-based Anthem and MDWise are pulling out of the Indiana Obamacare exchange. Anthem covered 46,000 Hoosiers in all 92 counties; MDWise covers 30,000, and it plans to emphasize service to the 370,000 Hoosiers in the Healthy Indiana Plan 2.0.
Under the U.S. House plan passed May 4, a rapid Medicaid defunding could destabilize the state’s hospital system, and the General Assembly could be faced with a HIP 2.0 funding gap in the hundreds of millions of dollars.
Donnelly used quotes from Trump last winter that he wanted to “blow up” Obamacare, then blame Democrats.
“I don’t want people to get hurt,” Trump told the Wall Street Journal. “What I think should happen, and will happen, is the Democrats will start calling me and negotiating.”
As Slate’s Jordan Weissmann observed, “Welcome to the Tony Soprano school of health policymaking.”
Donnelly explained, “If your house needs repairs, you don’t set the house on fire. You work to fix the issues.”
On Thursday, after Senate Republicans repeated the Democratic policy sin of 2009-2010 by developing a partisan health reform bill in secret, the details of the new legislation that could be voted on next week emerged, coming a week after Trump called the House-passed American Health Care Act “mean.”
When that plan passed May 4, he invited House Republicans over and celebrated with a Rose Garden beer party. Trump is clueless on the emerging details. He simply wants to sign something/anything and declare a big-deal victory.
For those of you who delve into policy, the Senate plan would, according to Axios and NBC’s First Read, keep subsidies like Obamacare but only up to 350 percent of the federal poverty level starting in 2020, not the Affordable Care Act’s 400 percent.
It will have a four-year reinsurance program to help state insurance markets. The ACA's cost-sharing reduction subsidies — one of the main things insurers say they need — would be funded through 2019.
States would get to waive some of the ACA's insurance regulations. Medicaid expansion will be phased out more slowly than in the House bill, ending the expansion in 2024. And there will be a $3,000 a year tax cut for Mr. Moneybags; Joe Sixpack’s will be in the $200 to $300 range, according to economist Steven Rattner.
NBC’s First Read notes, “Senate Majority Leader Mitch McConnell is calling this a ‘discussion draft,’ but the vote is still supposed to happen next week. Does the bill already include, for example, a dedicated fund to combat the opioid crisis? Are all its funding levels filled in — and final? On an already compressed timeline, how much negotiating will happen at the 11th hour?”
And Axios observes something that should make Sen. Young happy: Democrats (and Republicans) will have a "virtually unlimited opportunity to amend it during the budget process on the floor" next week, per Chairman Lamar Alexander.
So there will be high political drama as we head into the Fourth of July. Conservatives, like Kentucky U.S. Sen. Rand Paul, see the emerging Senate plan as “Obamacare Lite.”
Moderates, like Ohio Sen. Rob Portman and West Virginia’s Shelley Moore Capito, are wary of the Medicaid defunding. Both states, to a more severe degree than Indiana, are in the grips of the opioid/heroin/fentanyl pandemic, with Ohio expecting 30,000 overdose deaths this year.
The House-passed plan could have ended health coverage for up to 28 million people, according to the Congressional Budget Office. Its score of the Senate plan comes next week.
So the stakes are high. If Republicans don’t get this right, they will own it.