WASHINGTON — Senate Republican leader Mitch McConnell released his new but still-reeling health care bill Thursday, bidding for conservative support by letting insurers sell low-cost, skimpy policies and reaching for moderates with added billions to combat opioid abuse and help states rein in consumers' skyrocketing insurance costs.
However, allowing insurers to offer bare-bones plans threatens to alienate moderates and perhaps other conservatives. And the measure retains cuts in Medicaid — the health insurance plan for the poor, disabled and nursing home patients — that moderate Republican senators have fought.
The legislation, the Senate GOP's plan for rolling back much of President Barack Obama's health care law, faces a do-or-die vote next week on which McConnell has no margin for error. Since Democrats uniformly oppose the effort, McConnell needs the votes of 50 of the 52 GOP senators to prevail, and two seem certain to vote "no" — conservative Sen. Rand Paul of Kentucky and moderate Sen. Susan Collins of Maine.
Conservative Sen. Ted Cruz, R-Texas, has demanded language letting insurers sell plans with minimal coverage, as long as they also sell policies that meet strict coverage requirements set by Obama's 2010 statute. Moderate Republicans have objected that the idea would make policies excessively costly for people with serious illnesses because healthy people would flock to the cheaper coverage.
Sen. Mike Lee of Utah, who'd partnered with Cruz, tweeted that the version they crafted wasn't put in the bill, adding, "Something based on it has, but I have not seen it or agreed to it."
Adding to the uncertainty, the Cruz provision appeared in the legislative text in brackets, meaning specific language was still being composed. That could give McConnell, Cruz and other conservatives time to work out a provision with broader support.
The retooled measure retains McConnell's plan to phase out the extra money 31 states have used to expand Medicaid under Obama's statute, and to tightly limit the overall program's future growth. Since its creation in 1965, the program has provided open-ended federal funds to help states pay the program's costs.
The rewritten package would add $70 billion to the $112 billion McConnell originally sought that states could use to help insurers curb the growth of premiums and consumers' other out-of-pocket costs.
It has an added $45 billion for states to combat the misuse of drugs like opioids. That's a boost over the $2 billion in the initial bill and an addition demanded by ok
Republicans from states in the Midwest and Northeast that have been ravaged by the drugs.
To help pay for the added spending, the measure would retain three tax increases Obama's law slapped on higher- earning people to help finance his law's expansion of coverage. Under the current statute, families earning more than $250,000 annually got a 3.8 percent boost on their investment income tax and a 0.9 percent increase in their payroll tax. Obama also imposed a new tax on the salaries of high-paid insurance executives.
The revised bill would also allow people to use money from tax-favored health savings accounts to pay health insurance premiums, another favorite proposal of conservatives.
McConnell's new bill offered only modest departures from the original version, which he yanked off the Senate floor two weeks ago to avoid certain defeat at the hands of a broad range of unhappy Republicans.
The reworked measure's key elements remain. It would ease Obama's requirements that insurers cover specified services like hospital care, erase Obama's penalties on people who don't buy coverage and make federal health care subsidies be less generous.
In an interview Wednesday with the Christian Broadcasting Network's "The 700 Club," President Donald Trump said he will be "very angry" if the Senate fails to pass the health care measure and said McConnell must "pull it off."
Paul told reporters the revised measure has nothing "remotely resembling repeal."
Collins has long complained the measure will toss millions off coverage. Spokeswoman Annie Clarke said Collins would vote "no" next week "if the Medicaid cuts remain the same" as those that have been discussed.
Besides Paul and Collins, other Republican senators have also been noncommittal on whether they will back McConnell's bill next week, including Tim Scott of South Carolina and Rob Portman of Ohio.