AuthorTopic: The Death of Health Care  (Read 936 times)

Online Eddie

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Re: The Death of Health Care
« Reply #15 on: July 08, 2017, 04:37:43 PM »
I also had acquaintances who were willing to at least entertain the right-libertarian argument that property is an essential characteristic of being, and that to dilute my property for someone else‘s life — is a theft of my life. And they could make that argument in polite company and not be shunned.

To me, that is the most fundamental barrier preventing humane health insurance reform in the US.


I think this is a false argument. The author is just polishing his socialism.

Americans have the expectation that the healthcare system will never turn them away, because the tradition in American medicine is that no patients are turned away, at least not at public hospitals. If you are sick or injured and show up at the county hospital with no money, you still get treatment. This is the perceived safety net that makes working people think they can get away without having to pay insurance premiums. That and the fantasy that it won't happen to them, because they aren't sick and don't need health insurance anyway, so why spend the money.

Americans were fortunate that for a generation or two, most major corporate employers offered pretty good healthcare benefits as a part of the compensation package, leading to a strongly shared belief system among Americans that healthcare should be paid for by someone else other than them personally.

The aversion to funding the healthcare of the poor comes from a strongly held belief in poor white circles, that people who work have to pay, and that indigent people get healthcare for free. This, unfortunately,has been completely true, with the way Medicaid has evolved as a part of our fragmented delivery system. It's easy to understand the anger and frustration.

The other part is that there is a huge propaganda machine paid for by Big Insurance that keeps old people scared and willing to vote against the best interests of the people in this country.

There's much more in heaven and earth than are dreamt of in this writer's philosophy. He sees the problem through a narrow lens, to say the least.
What makes the desert beautiful is that somewhere it hides a well.

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Senate Republicans head back to work with no health-care deal
« Reply #16 on: July 10, 2017, 01:47:35 AM »
What sort of JOKE medical program do you think these Bozos will come up with?

The answer is simple.  Get rid of Insurance Companies and Slash the salaries of all people working in Medical Professions to $100K or less.  Then you can fund it.

RE


Senate Republicans head back to work with no health-care deal



Senate Majority Leader Mitch McConnell (R-Ky.) speaks to journalists after a Senate luncheon on Capitol Hill in April. (Melina Mara/The Washington Post)
By David Weigel July 9 at 2:22 PM

Senate Republicans returned to Washington from a holiday recess with new and deepening disagreements about their health-care bill, with key Republicans differing Sunday not merely on how to amend the bill, but also on whether a bill could pass at all.

“I would probably put that as 50-50,” Sen. Bill Cassidy (R-La.) said in a “Fox News Sunday” interview.

“They will get a repeal and replace bill done,” White House Chief of Staff Reince Priebus said on the same show.

“My view is it’s probably going to be dead,” Sen. John McCain (R-Ariz.) said on CBS’s “Face the Nation.”

Senate Majority Leader Mitch McConnell’s decision to push debate on the Better Care Reconciliation Act past the Independence Day recess was supposed to create space for dealmaking. “Legislation of this complexity almost always takes longer than anybody else would hope,” McConnell (Ky.) said at a June 27 news conference announcing the delay.
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Sen. John McCain (R-Ariz.) predicted the Republican bill to roll back Obamacare would likely fail in the Senate if put to a vote. (Reuters)

Instead, Republicans have run in different directions, proposing everything from a bipartisan deal to pay for insurance subsidies to a “repeal and delay” plan that would give them a few years before the Affordable Care Act would be fully gutted.

Sen. Ted Cruz (R-Tex.), the author of a “Consumer Freedom Option” amendment designed to bring conservatives on board with the bill, spent part of Sunday insisting that its critics were wrong. His amendment, also supported by Sen. Mike Lee (R-Utah), would allow insurers to once again offer cheaper plans that did not include the Affordable Care Act’s essential health benefits.

“You have millions of people who are winners straight off: young people,” said Cruz in a “Face the Nation” interview. “Young people get hammered by Obamacare. Millions of young people suddenly have much lower premiums.”

Over the recess, however, key Republicans told local media outlets that the amendment weakened protections that the party had promised to keep in place.

“I think that reopens an issue that I can’t support, that it would make it too difficult for people with preexisting conditions to get coverage,” Sen. Shelley Moore Capito (R-W.Va.) told the Charleston Gazette-Mail on Friday.

“There’s a real feeling that that’s subterfuge to get around preexisting conditions,” Sen. Charles E. Grassley (R-Iowa) told Iowa Public Radio on Wednesday. “If it is, in fact, subterfuge, and it has the effect of annihilating the preexisting conditions requirement that we have in the existing bill, then obviously I would object to that.”

On ABC’s “This Week,” Cruz said that colleagues such as Grassley were simply being misled. “What’s being repeated there is what [Senate Minority Leader Charles E.] Schumer said this week, which is that he called it a hoax,” he said. “Chuck Schumer and Barack Obama know a lot about health-care hoaxes.”

Schumer’s Democrats, meanwhile, have continued campaigning against the BCRA, saying that they will come to the table on health care only if Republicans give up on repeal. Throughout the recess, progressive activists, urged on by Democrats, protested and occupied the offices of Republican senators. On Friday, 16 protesters were arrested at the Columbus office of Sen. Rob Portman (R-Ohio), joining dozens arrested in civil disobedience around the country.

“We aren’t going to allow a handful of Socialists, many of whom are from New York, to disrupt our ability to serve the needs of the Ohio constituents who contact us in need of vital services every day,” Portman’s office said in a statement.

Still, opponents of the health-care bill were far more visible than its supporters. The pro-Trump organization America First Policies floated then abandoned a plan to organize pro-BCRA rallies. While no prominent Senate Democrats appeared on Sunday’s talk shows, Sen. Bernie Sanders (I-Vt.) spent the day rallying voters in West Virginia and Kentucky against the bill.

“Mitch McConnell is now trying to make side deals in order to win votes,” Sanders said in West Virginia. “I say to Senator Capito: Please do not fall for that old trick. This legislation is fatally flawed, and no small tweak here or there will undo the massive damage that it will cause to West Virginia and the entire country.”

Republicans, meanwhile, were openly talking about next steps if they could not amend the BCRA to win 50 votes. (Vice President Pence, who has signaled that the White House would sign off on any repeal bill, would cast the tiebreaking vote.) On “Fox News Sunday,” Cassidy suggested that his own bipartisan legislation to continue much of the Affordable Care Act could get a second look, and that in the meantime, Republicans could work with Democrats to provide more subsidies for private plans.

“I do think we have to do something for market stabilization,” said Cassidy. “Otherwise, people who are paying premiums of $20,000, $30,000 and $40,000 will pay even that much more.”

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Other Republicans, including McConnell, had warned that the BCRA’s failure would lead to a deal on subsidies. Yet conservatives, not ruling out the bill’s passage, spent the weekend talking up another backup plan. At a Republican fundraising dinner in Iowa, Sen. Ben Sasse (R-Neb.) suggested that Republicans could repeal most of the ACA, forcing Democrats to the table to work on a replacement.

“If we can’t replace and repeal at the same time, then repeal the law and stay and work on replace full time,” said Sasse.

On Fox, Cassidy — one of the Senate’s few physicians — said the repeal-and-delay plan was a fantasy.

“It gives all the power to people who actually don’t believe in President Trump’s campaign pledges, who actually don’t want to continue to cover and care for preexisting conditions and to lower premiums,” Cassidy said. “It gives them the stronger hand. I think it’s wrong.”
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http://www.businessinsider.com/senate-republican-healthcare-bill-vote-when-2017-7

'WE WILL GO FROM MAJORITY TO MINORITY': It's starting to look ugly for the GOP healthcare bill

    Bob Bryan


Senate Majority Leader Mitch McConnell. Mark Wilson/Getty Images

Senate Republicans are set to come back from a week-long recess facing ever-dimming chances to pass their stalled healthcare legislation.

Continued public pressure and few concrete solutions have left the Better Care Reconciliation Act (BCRA) seemingly further away from passage than before the July 4 break.

A week in which lawmakers have faced pressure from constituents at home has left the legislation's math on the wrong side of passage, as moderates and conservatives continue to disagree about fundamental issues within the bill.

On Sunday, many Republicans openly questioned whether or not the GOP will be able to deliver on a bill before the August recess.

Sen. Chuck Grassley, who expressed misgivings about the current form of the BCRA in meetings last week, took to Twitter to express displeasure with the current state of affairs in the healthcare debate.

"52 Republicazn [sic] senators shld be ashamed that we have not passed health reform by now WE WONT BE ASHAMED WE WILL GO FROM MAJORITY TO MINORITY," Grassley tweeted.

Sen. John McCain was also downbeat during an appearance on CBS's Face the Nation.

"I think my view is it's probably going to be dead, but I've been wrong," McCain said. "I thought I'd be president of the United States. But I think, I fear, that it's going to fail."

Sen. Bill Cassidy of Lousiana also also declared the current BCRA "dead" in an appearance on "Fox News Sunday." He placed the odds of a deal at "50-50."

Senate Majority Leader Mitch McConnell can only afford to lose two votes on the BCRA with universal Democratic opposition. Republican leadership is now targeting the week of July 17 for a vote on the bill, reports have suggested.

"Discussions with members and the CBO continue," an aide to McConnell told Business Insider.

But given the tumultuous week, many GOP lawmakers are already looking ahead to what happens if the bill fails.

"Republicans we talk with are impatient — they want to ditch the health debacle and move on to pivotal budget issues and then, of course, begin deliberating tax cuts," said Greg Valliere, the chief global strategist at Horizon Investments.
Public pushback

The most apparent troubles for the Republican conference came in the form of public reaction to their healthcare bill, which a survey this week showed had 17% support from US voters.

In a variety of public events and forums over the week-long recess, GOP lawmakers got an earful from constituents among the 83%. Even members who opposed the initial version of the healthcare legislation faced pressure.

Sen. Susan Collins of Maine received from praise from constituents for her strong stance against the BCRA, but some implored her to remain steadfast in her opposition during a July 4 parade in Eastport, Maine.

Sen. Jerry Moran of Kansas also faced pressure to maintain his stance against the legislation during a town hall on Thursday. Typically a safe bet to stick behind the GOP leadership, Moran repeatedly expressed his misgivings over the BCRA.

"The Affordable Care Act creates significant difficulties that still need major attention," Moran told reporters after the town hall. "But I think at this point, it's time to figure out how ... to get rid of the bad things and improve on the things that need to be improved."

Moran was one of only a handful of Republicans to hold events open to the public, including BCRA skeptics Cassidy (who favors a more moderate approach) and Ted Cruz (who wants a stronger repeal). Cruz is pushing for an amendment to be added to the bill favored by conservatives, which would make it easier for states to opt out of certain Obamacare regulations.

Cruz also faced fervent pushback at various meetings around Texas. According to The Washington Post, Cruz repeatedly encountered protesters and continually reiterated his desire to repeal the ACA.
Threading the needle

Other GOP senators seemed to move further away from supporting the legislation during the break. And for differing sides in the caucus, that could lead to drastically different alternatives.

Sen. John Hoeven of North Dakota — who, like Moran, typically sides with leadership, said he was opposed to the BCRA in its current form during a meeting with constituents and health officials, according to the Bismark Tribune.

This presented another potential defection for McConnell, who spoke at a private function about the possibility of working with Democrats if Republicans are unable to pass the legislation.

"If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur" the Kentucky senator said.

McConnell also said that "no action is not an alternative."

Similarly, Cruz expressed skepticism over the possibility of passage during meetings in Texas throughout the week. The one-time presidential candidate, however, had a different end result if Republicans are unable to work out a compromise.

"If we cannot bring the conference together and agree on repeal legislation, then I think President Trump’s absolutely right that we should pass a clean repeal," Cruz said.

That approach is favored by Cruz and others like Sens. Rand Paul and Ben Sasse. Trump has also suggested moving forward with a simple Obamacare repeal bill if negotiations fall apart. That would at least, they say, fulfill a key GOP promise and allow lawmakers more time to draft an acceptable replacement.

But McConnell and more moderate members would rather work with Democrats on a short-term plan to stabilize the insurance markets, lest they deteriorate even worse. Based on polling from the Kaiser Family Foundation, a nonpartisan health policy think tank, voters are more inclined to pin any further harm to the healthcare market on Republicans.
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Offline agelbert

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Re: It's starting to look ugly for the GOP
« Reply #18 on: July 10, 2017, 12:01:52 PM »
http://www.businessinsider.com/senate-republican-healthcare-bill-vote-when-2017-7

'WE WILL GO FROM MAJORITY TO MINORITY': It's starting to look ugly for the GOP healthcare bill

    Bob Bryan

 
Senate Majority Leader Mitch McConnell.  Mark Wilson/Getty Images

Senate Republicans are set to come back from a week-long recess facing ever-dimming chances to pass their stalled healthcare legislation.

Continued public pressure and few concrete solutions have left the Better Care Reconciliation Act (BCRA) seemingly further away from passage than before the July 4 break.

A week in which lawmakers have faced pressure from constituents at home has left the legislation's math on the wrong side of passage, as moderates and conservatives continue to disagree about fundamental issues within the bill.

On Sunday, many Republicans openly questioned whether or not the GOP will be able to deliver on a bill before the August recess.

Sen. Chuck Grassley, who expressed misgivings about the current form of the BCRA in meetings last week, took to Twitter to express displeasure with the current state of affairs in the healthcare debate.

"52 Republicazn [sic] senators shld be ashamed that we have not passed health reform by now WE WONT BE ASHAMED WE WILL GO FROM MAJORITY TO MINORITY," Grassley tweeted.

Sen. John McCain was also downbeat during an appearance on CBS's Face the Nation.

"I think my view is it's probably going to be dead, but I've been wrong," McCain said. "I thought I'd be president of the United States. But I think, I fear, that it's going to fail."

Sen. Bill Cassidy of Lousiana also also declared the current BCRA "dead" in an appearance on "Fox News Sunday."


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Republican attempts to replace Obamacare fail
« Reply #19 on: July 18, 2017, 12:48:18 AM »
http://www.bbc.com/news/world-us-canada-40639909

Republican attempts to replace Obamacare fail

    43 minutes ago
    From the section US & Canada

Media captionPresident Trump won big in Kentucky last year but the state also depends heavily on Obamacare

Republican efforts to find a replacement for President Obama's healthcare system have collapsed.

Two Republican senators said they opposed their party's proposed alternative, making it impossible for the bill to pass in its current form.

The party has been divided on the issue, with moderates concerned about the effects on the most vulnerable.

President Trump has now called for repeal of Obamacare, so Republicans can start "from a clean slate".

That task falls to Senate Majority Leader Mitch McConnell.

"Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful," Mr McConnell said.
What had been proposed?

President Trump had made repealing and replacing Obamacare, under which more than 20 million people gained healthcare coverage, a key campaign pledge.

Republicans view Obamacare as an overreach of the federal government and say patients have less choice and higher premiums.

The party's proposed alternative had kept key Obamacare taxes on the wealthy, while imposing sharp cuts to healthcare for the poor and allowing insurers to offer less coverage.

Congress has been delaying its summer holiday in a bid to overturn President Obama's 2010 legislation.

    Why is Obamacare so controversial?
    Obamacare v Republican plan compared

Why has it failed?

Two Republican senators, Mike Lee and Jerry Moran, said the new legislation did not go far enough in repealing Obamacare.

Mr Moran said "we should not put our stamp of approval on bad policy" while for Mr Lee, "in addition to not repealing all of the Obamacare taxes [the bill] doesn't go far enough in lowering premiums for middle class families; nor does it create enough free space from the most costly Obamacare regulations".
Media captionHealthcare battle in rural America

Two senators - Rand Paul and Susan Collins - had already opposed the bill. Mr Paul said the bill kept too much of the "ObamaCare taxes", while Ms Collins expressed concerns about cuts to Medicaid.

With the two new opponents, Republicans - who hold 52 seats - no longer have enough votes to pass the bill in the 100-member Senate.

    'I owe my life to Obamacare'

Moderate Republicans had also said the bill would have harmed some of their vulnerable constituents.

The non-partisan Congressional Budgetary Office (CBO) found the bill would have stripped 22 million Americans of health insurance over the next decade.

On top of that, polls had shown Obamacare remained popular among Americans - a survey by the Washington Post and ABC News on Monday found more than twice as many people preferred Mr Obama's programme to the proposed alternative.
Analysis: The end of repeal-and-replace war?

By Anthony Zurcher, BBC North America reporter

In the end the death blow to the latest iteration of Obamacare repeal came from the right flank.

Mr McConnell was always going to have to walk a fine line in his effort to keep both moderates and hard-core conservatives in party on board with his healthcare reform proposal. After his first draft failed to garner sufficient support, he came out with a new version that moved farther to the right in key areas while throwing money to keep the moderates satiated.

That strategy worked in the House, where Freedom Caucus arch-conservatives and just enough moderates came around to rescue the legislation from death's doorstep.

This time the entire rickety structure came tumbling down. The Senate may very well try to vote on straight-up repeal, as the president has suggested - one with a two-year fuse - but it faces long odds in winning a majority support. If and when that fails, it's back to the drawing board for Republicans.

This isn't the end of congressional efforts to pass healthcare legislation. But it's likely the end of the repeal-and-replace war as it's been waged for the past six months.

    Read Anthony's analysis in full

What happens now?

Reacting to what is being seen as a significant setback, Mr Trump urged Republicans to repeal the "failing Obamacare now and work on a new healthcare plan that will start from a clean slate".

Mr McConnell said he would try to pass a repeal of Obamacare with a two-year delay implementation that would provide a "stable transition period" to a new legislation.

Correspondents, however, say that this plan has little chance to pass as, under the interim period, millions would be left without healthcare.

    Trump country: Don't take our healthcare

Republican Senator John McCain, who is recovering from surgery in his home state of Arizona, called for a bipartisan strategy to produce a new bill.

"The Congress must now return to regular order, hold hearings, receive input from members of both parties," he said in a statement.
Media captionTrump's battles with Obamacare - in his own words

Democrats have said they will not co-operate to repeal Obamacare, but that they can work in a bipartisan way to improve it.

Senate Democratic Leader Charles Schumer said on Twitter: "This second failure of Trumpcare is proof positive that the core of this bill is unworkable."

Senator Bernie Sanders, a former Democratic presidential contender, said: "This is a great victory for the millions of Americans who stood up and fought back against this dangerous legislation."
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Senate Votes Down Broad Obamacare Repeal
« Reply #20 on: July 26, 2017, 12:46:52 AM »
https://www.nytimes.com/2017/07/25/us/politics/senate-health-care.html

Politics
Senate Votes Down Broad Obamacare Repeal

By THOMAS KAPLAN and ROBERT PEARJULY 25, 2017


The Senate majority leader, Mitch McConnell of Kentucky, at the Capitol on Tuesday. Credit Gabriella Demczuk for The New York Times

WASHINGTON — The Senate voted narrowly on Tuesday to begin debate on a bill to repeal major provisions of the Affordable Care Act, but hours later, Republican leaders suffered a setback when their most comprehensive plan to replace President Barack Obama’s health law fell far short of the votes it needed.

The Tuesday night tally needed to reach 60 votes to overcome a parliamentary objection. Instead, it fell 43-57. The fact that the comprehensive replacement plan came up well short of even 50 votes was an ominous sign for Republican leaders still seeking a formula to pass final health care legislation this week.

For Republicans, the failure ended the day on a sour note, hours after a more triumphant scene on the Senate floor. Lawmakers from both parties had risen to their feet in the afternoon and applauded when Senator John McCain, Republican of Arizona, showed up in the chamber despite his diagnosis of brain cancer. He cast a crucial vote in favor of opening what promises to be a freewheeling, hard-fought debate over the future of the Affordable Care Act.

The 51-50 vote to start debate, with Vice President Mike Pence breaking a tie, came only a week after the Republican effort to dismantle a pillar of Mr. Obama’s legacy appeared all but doomed. It provided an initial win for President Trump, who pushed, cajoled and threatened senators in recent days to at least begin debating the repeal of the health care law.

But the victory could be fleeting: Senate Republicans still have no agreement on a repeal bill that they can ultimately pass to uproot the law that has provided health insurance to millions of Americans.
How Each Senator Voted on Full Obamacare Repeal-and-Replace

Republican leaders brought the first of several expected amendments to a vote Tuesday night.

The Senate is now moving ahead with debate, amendments and ultimately a final vote in the coming days on legislation that would have a profound effect on the American health care system — roughly one-sixth of the United States’ economy. But it is entirely possible that by week’s end, the senators will have passed nothing.

“Now we move forward towards truly great health care for the American people,” Mr. Trump said from the White House Rose Garden, where he was holding a news conference with the visiting prime minister of Lebanon. “This was a big step.”

Only two Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, voted against the procedural motion, though at least several other Republicans had been seen as possible holdouts. No Democrats voted in favor of the motion.

The Tuesday night vote was on a comprehensive amendment that included disparate proposals calculated to appeal to conservatives and moderates in the Republican caucus.

One proposal, offered by Senator Ted Cruz, Republican of Texas, would have allowed insurers to sell stripped-down health plans, without maternity care or other benefits required by the Affordable Care Act, if they also sold plans that included such benefits.

“You shouldn’t have to buy what the federal government mandates you must buy,” Mr. Cruz said. “You should choose what meets the needs for you and your family.”
Graphic
Republicans Are Voting This Week to Repeal or Replace Obamacare. Here Are Their Proposals.

Three major proposals are being discussed.
OPEN Graphic

The amendment also included money to help pay out-of-pocket medical costs for low-income people, including those who buy private insurance after losing Medicaid coverage as a result of the Senate bill. This proposal was devised by Senator Rob Portman, Republican of Ohio, and other senators from states that have expanded Medicaid under the Affordable Care Act.

But nine Republicans, spanning the party’s ideological spectrum, voted against the package.

The debate to come will have broad implications for health care and households in every state, and emotions are high.

Before senators voted to start the debate in midafternoon, protesters in the Senate gallery chanted, “Kill the bill, don’t kill us!” and “Shame, shame, shame!”

Despite his vote to move ahead, Mr. McCain offered harsh words for the secretive process by which Senate Republican leaders came up with their bill to repeal and replace the health law, and he delivered a pessimistic take on its chances.

“Asking us to swallow our doubts and force it past a unified opposition — I don’t think that’s going to work in the end, and probably shouldn’t,” Mr. McCain said, adding that it “seems likely” that the current repeal effort would end in failure. Still, Mr. McCain voted with Republican leaders in favor of the comprehensive replacement plan on Tuesday night.

Arizona is one of the 31 states that expanded Medicaid under the Affordable Care Act, and Mr. McCain’s remarks could reflect concerns of other senators from states that expanded Medicaid, including the junior Republican senator from his state, Jeff Flake.
Video
John McCain to Senate: ‘We’re Getting Nothing Done’

Senator John McCain, who was recently diagnosed with brain cancer, spoke to the Senate after casting his vote to begin debating legislation to repeal the Affordable Care Act. By THE ASSOCIATED PRESS. Photo by Gabriella Demczuk for The New York Times. Watch in Times Video »

    embed

“We are ground zero for the failure of the exchanges, but we are also an expansion state,” Mr. Flake said. “I think all of us are concerned that we don’t pull the rug out from people.”

Just before the Senate vote, the Democratic leader, Chuck Schumer of New York, made an impassioned plea to Republicans.

“We know that A.C.A. is not perfect,” Mr. Schumer said. “But we also know what you’ve proposed is much worse. We can work together to improve health care in this country. Turn back now before it’s too late and millions and millions and millions of Americans are hurt so badly in ways from which they will never, ever recover.”

Given the divisions within their caucus, Senate Republican leaders were considering a new approach to keeping their repeal quest alive: They could try to reach agreement on a slimmed-down bill that would repeal a few major provisions of the Affordable Care Act, like the penalties imposed on people who go without insurance and businesses that do not offer insurance to their employees. Republican leaders would not intend such a bill to become law, but they believe that it could win approval in the Senate.

That “skinny” bill could then be a basis for negotiations with the House.

Republican leaders in Congress have struggled all year to fulfill their promise of repealing the 2010 health care law. By a vote of 217 to 213, the House approved a repeal bill in early May, but only after Republicans overcame their own difficulties in that chamber.

Mr. Trump kept up pressure on the Senate on Tuesday with Twitter posts. After the procedural vote, he applauded the Senate, but was cutting toward Ms. Collins and Ms. Murkowski: “We had two Republicans that went against us, which is very sad, I think. It’s very, very sad for them.”
How Senators Voted to Consider the Republican Health Care Bill »
Majority needed to pass    Yes    No
Republicans    51    2
Democrats    0    48
Total    51    50

The successful procedural vote was also a moment of redemption, at least temporarily, for Senator Mitch McConnell of Kentucky, the majority leader, who just last week appeared to have failed in his effort to put together a health bill that could squeak through the narrowly divided Senate.

That said, it remained far from certain whether Republicans would be able to agree on a bill in the days to come — and what exactly the contents of that bill would be. Mr. McConnell promised an “open amendment process” in which members of both parties could propose changes.

“This is just the beginning,” Mr. McConnell said. “We’re not out here to spike the football.”

For weeks, Mr. McConnell has been promoting and revising a comprehensive bill that would repeal the health law while also replacing it, but he has struggled to nail down the support needed to pass that measure. The nonpartisan Congressional Budget Office has yet to assess the most complete version of that legislation, which includes the proposals by Mr. Cruz and Mr. Portman.

Without that assessment, the measure needed 60 Senate votes, and it failed that test on Tuesday night.

The Senate is also expected to vote on a measure that would repeal the health law without putting in place any replacement, but that approach does not appear to have enough support to pass, either.l

That proposal resembles a bill passed by the Senate in 2015 and vetoed by Mr. Obama in early 2016. But it would increase the number of people who are uninsured by 32 million in 2026, the budget office said.

Mr. Portman had anguished for weeks over provisions of Mr. McConnell’s repeal bill that would make deep cuts in projected Medicaid spending and roll back the expansion of the program under the Affordable Care Act.

Mr. Portman voted to move ahead with the debate on Tuesday after being assured that the Senate would vote on his plan to provide financial assistance to people moving from an expanded state Medicaid program to private health insurance.

States could have used the money, totaling $100 billion, to help low-income people pay deductibles and other out-of-pocket costs when they receive medical care.

Mr. Portman worked on the plan with the Trump administration and with several other Republican senators from states that have expanded Medicaid, including Shelley Moore Capito of West Virginia and Dean Heller of Nevada.

Mr. Heller voted Tuesday to open the debate, but he made no commitment to vote for the repeal bill itself.

“If the final product isn’t improved for the state of Nevada, then I will not vote for it,” Mr. Heller said. “If it is improved, I will support it.”

Reporting was contributed by Avantika Chilkoti, Emily Cochrane, Julie Hirschfeld Davis and Jennifer Steinhauer.


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