In hearing, Sen. Roberts defends GOP health care proposal

Republican Sen. Pat Roberts of Kansas, a member of the Senate Finance Committee, defends a GOP health care bill to repeal and replace the Affordable Care Act during the bill's one and only committee hearing Monday.

Republican U.S. Sen. Pat Roberts of Kansas argued Monday that Kansas would come out ahead under a GOP-backed bill that would repeal and replace the Affordable Care Act, also known as Obamacare.

During the bill’s one and only hearing before the Senate Finance Committee, Roberts also said that his constituents in Kansas were demanding an overhaul of the program.

“When I was back home at the state fair in Hutchinson, Kan., just a couple of weeks ago, there was nothing but concern and frustration, and, yes, even anger, from my constituents over Obamacare’s failures, and questions — if not demands — over why we here in the Senate have not successfully passed reform,” Roberts said.

The bill being considered in the Senate, known as the Graham-Cassidy-Heller-Johnson Act after its four main authors, is the third attempt this year to repeal and replace former President Barack Obama’s signature piece of health care legislation.

It would repeal the expanded Medicaid program that allowed states to extend Medicaid to virtually all individuals in households with incomes below 138 percent of the poverty level. It would also repeal the subsidies and tax credits that moderate-income individuals receive to buy individual health coverage through online exchange markets.

In place of those programs, the bill calls for sending a smaller amount of money directly to states in the form of block grants for the years 2020 through 2026. It would also cap the growth rate in Medicaid by imposing per capita caps in spending.

In questioning one of the four authors, Sen. Bill Cassidy, R-La., Roberts said the Kansas Medicaid program is expected to grow by about 3 percent per year for the next few years, but that the GOP bill would cap Kansas’ growth rate at a higher level, 4 percent.

“There are two aspects to your state,” Cassidy said to Roberts. “The traditional block grant, if you will. Kansans will have lots of money for cancer screening, etc. In Kansas, you’ll go from receiving $2.9 billion from 2020 to 2026 under current law. Under our proposal, you would get $4.7 billion from 2020 to 2026 to provide cancer screening and cancer treatment for lower-income Kansans.”

The bill has been harshly criticized by Democrats, health care advocates and major hospital and medical groups because it would also repeal both the individual and large-employer insurance coverage mandates under the Affordable Care Act. It would give states the option of redefining what constitutes an “essential benefit” for insurance policies, and it would allow states to assign people with pre-existing conditions to separate high-risk pools.

Roberts, however, argued that he believes those criticisms are overstated.

“Let’s say a state submits a waiver to redefine essential health benefits, that’s been a concern,” Roberts said to Cassidy. “Would prior state-mandated benefits stay in effect, or are we looking at a wild west like some are claiming?”

“No,” Cassidy said. “There’s a supposition that governors are not going to take care of the people in their state, which kind of underlies all these questions by some who have opposed the bill. I disagree; I think governors want to take care of the folks in their state. But if they apply for a waiver, the statute specifically says that the governor must establish that those with pre-existing conditions have access to adequate and affordable coverage.”

If governors fail at that and misuse funds, Cassidy went on to say, the law has a provision in which the secretary of Health and Human Services can “both deny and pull dollars back.”

Republicans are pushing to pass the bill this week, before the fiscal year ends Sept. 30, so they can use what’s called a “budget reconciliation” process to pass the bill. Under that process, they need only a simple majority of 51 vote for passage. After Sept. 30, they would need 60 votes to end debate on the bill and bring it to a final vote.

Republicans currently have only 52 seats in the Senate, plus the vice president’s tie-breaking vote, if necessary. Two GOP senators, John McCain of Arizona and Rand Paul of Kentucky, have already said they will oppose the bill. Two others, Susan Collins of Maine and Lisa Murkowski of Alaska, have said they have serious concerns about the bill.

Kansas’ junior senator, Jerry Moran, has not yet said whether he will support the bill.