Single-payer? The Senate voting heads toward ‘skinny bill’ Single-payer? The Senate voting heads toward ‘skinny bill’
The health care talkathon that consumed the U.S. Senate on Thursday afternoon included a seemingly strange vote on launching a “single-payer’’ government-run system. The amendment was... Single-payer? The Senate voting heads toward ‘skinny bill’

The health care talkathon that consumed the U.S. Senate on Thursday afternoon included a seemingly strange vote on launching a “single-payer’’ government-run system.

The amendment was introduced by, of all people, a Republican – Sen. Steve Daines of Montana.

Sanders

It drew exactly zero ‘’Yes’’ votes. That included liberal Sen. Bernie Sanders of Vermont, a longtime advocate of single-payer, which would install a Medicare-like system for everyone. Republicans have consistently opposed such a move.

Democrats and their allies, including Sanders, denounced the Thursday amendment as a GOP maneuver to get them on the record regarding their support — or lack thereof — for a single-payer system. Senators voted 0-57 on the amendment.

The single-payer vote was part of the spectacle surrounding Thursday’s Republican attempt to get some form of health care legislation passed in the Senate and move toward a compromise with the House.

Republicans, including congressional leaders, have vowed for years to repeal and replace the 2010 Affordable Care Act, and President Trump made that cause central to his campaign. But after House passage of its own overhaul legislation, the Senate this week rejected both a comprehensive “repeal and replace’’ measure and also a straightforward repeal proposal.

GOP senators, though, appeared to be coalescing around a stripped-down version that would roll back Obamacare’s individual and employer coverage mandates. The so-called “skinny repeal’’ is also expected to remove the tax on medical device makers.

The measure had not surfaced by late afternoon.

The Washington Post reported Thursday that the stripped-down measure would eliminate funds for preventive health care provided under the 2010 ACA and transfer the funds that Planned Parenthood would receive for one year to community health centers. Finally, the measure would provide states more flexibility in how they administer their Medicaid programs under the law’s 1332 waiver program.

The chamber is expected to take up the proposal either late Thursday night or Friday morning.

The GOP goal would be that Senate Republicans pass their own measure and then began a conference with the House, where Republicans have a stronger edge, with lawmakers from the two chambers negotiating on a final bill.

(Here’s what the legislative process would look like if the “skinny repeal” passes.)

“It is being called a skinny bill because it won’t have much in it,” said Sen. Lamar Alexander (R-Tenn). “It is not a solution to the Affordable Care Act problems. But it is a solution on how we can get to a place where we can write a solution to the Affordable Care Act.”

Getting rid of the ACA requirement that most individuals obtain coverage, which is part of the proposed skinny bill, has sparked a stark warning from the health insurance industry.

The industry group America’s Health Insurance Plans wrote to Senate leaders Thursday saying that ending the requirement that people buy insurance, unless other provisions are included to strengthen insurance markets, would produce “higher premiums, fewer choices for consumers and fewer people covered next year.”

Graham

A bipartisan group of governors, including Republicans John Kasich of Ohio and Brian Sandoval of Nevada, also announced they are against the “skinny’’ bill.

In an analysis sought by Senate Democrats, congressional budget analysts are estimating that the changes would leave an additional 1 million Americans uninsured this year, because consumers would immediately become free to drop coverage. At the end of the coming decade, 16 million extra people would be uninsured, according to the nonpartisan budget scorekeepers.

And some senators worry that they are being asked to vote for legislation they don’t like on a promise that it won’t become law. But they have no guarantee that the House won’t take it up and pass the “skinny’’ bill by itself.

GOP senators Lindsey Graham of South Carolina and John McCain of Arizona called on the House to promise it would not accept the pared-down version as the final legislation, but instead allow the bill to go to a conference committee for substantial revisions. Graham called the “skinny” legislation  “a disaster” and “a fraud.”

Part of the drama Thursday will include what the Senate parliamentarian rules is germane to the legislative process.

Bills advanced under reconciliation can’t be filibustered — which is key when there are only 52 Senate Republicans, fewer than the 60 needed to stop a filibuster. But under the “Byrd rule,” all provisions in the measures must directly relate to the budget. The Senate parliamentarian gets to decide what fits under that description and what doesn’t.

“The biggest news I’ve seen is that the Senate Parliamentarian is taking a hard line on her Byrd rulings,’’ said Kelly McCutchen of the free-market supporting Georgia Public Policy Foundation. “This will cause some recalibration. There was a wide variety of opinions regarding what was possible under reconciliation – this narrows the list significantly but may actually help the chances of reaching consensus on a final bill.’’

Ominously for Georgia, the giant insurer Anthem said Wednesday that said that if it doesn’t get more certainty soon about the future of the ACA exchanges, it will likely further pull back its planned participation for next year, the Wall Street Journal reported.

Anthem is the parent company of Blue Cross and Blue Shield of Georgia, which is the only insurer in the health insurance exchange in 96 of Georgia’s 159 counties. A retreat by Blue Cross from the exchange would devastate the state’s marketplace.

The big insurer emphasized that it needs answers about the future of federal payments that allow for reduced out-of-pocket costs for low-income ACA exchange-plan enrollees. CEO Joseph R. Swedish said that without greater clarity, especially around the cost-sharing payments, “we will need to revise our rate filings to further narrow our level of participation,” the Journal reported. He added that the insurer may make decisions “in a relatively short period of time” and in September at the latest.

Anthem will “only participate in rating regions where we have an appropriate level of confidence that these markets are on a path towards marketplace stability,” Swedish said.

Stephens

Beth Stephens of the consumer group Georgia Watch said Thursday afternoon, “We are very concerned about possible repeal of the individual and employer mandates, which would throw the insurance market into a tailspin. Reductions in Medicaid funding for Georgia would have a devastating effect on many vulnerable Georgians — children, people with disabilities, and the elderly.  Decisions about the future of health care should not be made in such a chaotic fashion. We are urging senators to vote down these current proposals, return to regular order and work across the aisle.”

Trump tweeted his encouragement Thursday morning: “Come on Republican Senators, you can do it on Healthcare. After 7 years, this is your chance to shine! Don’t let the American people down!”

The Senate process is expected to stretch well into the night.

“I think it is quite likely we will be here much of the night, if not all night,” said Sen. Ted Cruz (R-Texas). “And at the end of it hopefully we’ll have a bill that can bring us together.”

 


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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