With the Senate Republican healthcare bill at an impasse, Republican leaders are weighing a proposal from Sen. Ted Cruz to try to move it over the finish line.
Cruz’s plan, which is also supported by Sen. Mike Lee of Utah, proposes to change the type of insurance plans that could be offered under the Better Care Reconciliation Act (BCRA).
The plan has drawn widespread praise in conservative circles over the past several days. But even if it brings Cruz and fellow conservative-leaning senators on board, it may turn away more moderate members of the caucus.
Given that political reality, Senate Majority Leader Mitch McConnell on Thursday suggested that Republicans might have to work with Democrats to solve healthcare.
Cruz’s solution does, however, have backing from President Donald Trump’s White House.
“We support Sen. Cruz and Sen. Lee’s efforts,” said Marc Short, the White House director of legislative affairs, on “Fox News Sunday.”
‘A recipe for instability’
The Cruz plan would allow insurers to offer plans in the individual insurance market that do not adhere to two major regulations imposed under the Affordable Care Act, or Obamacare, as long as they offer one that does.
So-called essential health benefits (EHBs) require insurers to cover 10 basic benefits, including maternity care, mental healthcare, and emergency-room trips. Community rating, the other mandate under Obamacare, requires that people of the same age in a given area be charged the same amount for premiums. That helps people with preexisting conditions to not be charged more for care.
Cruz has argued that the virtual repeal of those mandates would allow insurers to offer cheaper plans to people that want them and bring down costs for everyone.
But experts say it could mean that plans that feature EHBs and community rating could be priced higher than those without — to the point that they become too expensive for the people that need them. The two tiers of plans, experts say, could allow insurers to box sick people into the more generous plans at a higher cost.
“Choice always sounds so good, like with the Cruz amendment,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation, a nonpartisan health policy think tank. “But in insurance, it’s generally a recipe for instability and discrimination.”
A growing number of fans
The proposed Cruz amendment has begun to gather praise from lawmakers and outside groups on the right flank of the Republican Party.
For one thing, conservative holdouts in the Senate appear to be supportive of the plan. Lee has advocated for the amendment and has made its addition a virtual deal-breaker for his vote.
“We can’t speak for other members,” a Lee aide told Business Insider. “But we will not vote for the Senate bill without this change.”
Other non-committal senators, such as Rand Paul of Kentucky, have not commented on the proposal.
The traction around the amendment was enough, however, to prompt Republican leadership to send the bill to the Congressional Budget Office to be scored, alongside another tweaked version of the bill without the amendment.
It may also clear a way for the Senate’s bill to pass the House. Upon the BRCA’s release, reports suggested that House GOP leadership would be open to passing the Senate’s version of a bill as it stood. But conservatives in the chamber, such as the House Freedom Caucus, brushed back at that plan.
The Cruz amendment could change that since it resembles amendments that won over House conservatives during the production of the American Health Care Act, the House’s legislation, in May. According to a source close to the Freedom Caucus, the Senate bill with a Cruz-like amendment could garner the support of the key conservative group.
“The group generally supports it but hasn’t taken any formal position so it’d be too soon to say if the full group supports it,” the source told Business Insider. “For example, if pro-life protections fall off, a lot of HFC will oppose regardless of Cruz.”
Rep. Mark Meadows, the chair of the Freedom Caucus, has expressed support for the addition.
Outside of Capitol Hill, conservative groups have also praised Cruz’s suggestion.
Influential conservative groups like the Heritage Foundation’s political arm and FreedomWorks expressed support for the idea.
“We continue to believe that the best outcome is language modelled after the 2015 reconciliation bill that repealed much of Obamacare,” FreedomWorks President Adam Brandon said in a statement Wednesday. “But if Senate Republicans insist on tweaking Obamacare, we urge them to adopt language being pushed by Sens. Cruz and Lee that will provide consumers with more choice and truly affordable health insurance coverage.”
Heritage Action CEO Michael Needham had similar praise in a statement.
“It is encouraging to see Senate leadership exploring the merits of serious proposals that would inject much-needed consumer choice and competition into an otherwise deteriorating market,” Needham said.
Victory? That’s no guarantee
Cruz’s plan changes the political calculus for the bill. But so far, it’s unclear if it could get Republicans the 50-vote threshold they need to pass the legislation.
The key holdup would likely be moderates in the Republican conference. Those that already oppose the bill, like Sen. Susan Collins and Dean Heller, would be unlikely to come on board since they are concerned about some of what the BCRA already proposes to do to change certain features of Obamacare.
The amendment may also lose uncommitted GOP senators, like Louisiana’s Bill Cassidy.
Cassidy has said that any plan must adhere to the “Kimmel Test.” The barometer, named after late night host Jimmy Kimmel, stipulates that any Republican bill must preserve all protections for people with preexisting conditions. Given the Cruz amendment’s proposed changes, it would likely not qualify.
While moderate GOP senators are the most important point of opposition for Republican leaders, the proposed changes to the insurance market that would occur under the Cruz plan drew the ire of Democrats. Senate Minority Leader Chuck Schumer blasted the amendment in a statement on Thursday, saying it would raise out-of-pocket costs and harm people with preexisting conditions.
“Make no mistake, the Cruz amendment is a hoax,” Schumer’s statement said. “Under the guise of lowering premiums, it makes healthcare more expensive because deductibles and copayments would be so onerous that many Americans would pay much more out of their pockets than they pay today. It’s a foolhardy trade to exchange lower premiums for far more expensive deductibles and copayments.”
The Senate reconvenes next week after its July 4 recess, but a vote on the healthcare bill is not expected right away.
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