Senate Republicans plan to unveil their second attempt at repealing and replacing the Affordable Care Act on Thursday, hoping to find a legislative sweet spot to attract 50 votes for the bill and keep their long-standing promise to dismantle former President Barack Obama’s signature legislative achievement.
But passing this bill is just the beginning of fixing problems with the nation’s health care industry, said Sen. Thom Tillis of North Carolina.
“What most people fail to mention when they oppose the bill is that this is not a once-and-done process. This is the first step of a series of legislative actions we’ll have to take and administrative actions to fix it,” said Tillis, a first-term Republican. “We need to put in a foundation we can build on.”
Getting enough support to pass a first attempt at repeal and replace has proven difficult, however.
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The House narrowly passed a bill — the American Health Care Act — after its initial attempt stalled. The Senate planned a vote on its own proposal before its Fourth of July break, but Republican leaders were forced to abandon that plan due to a lack of support among both conservative and moderate members of the caucus.
The Congressional Budget Office found that 22 million more Americans would be without health insurance by 2026 if the Senate bill became law.
Unlike several Republican colleagues, neither Burr nor Tillis have publicly expressed reservations about the bill.
Even a revised bill, which is likely to include concessions to both the left and right of the party, faces an uncertain fate in the Senate.
In March, before the House passed its version of the bill, President Donald Trump suggested reform would be a three-step process, including regulatory fixes and a second piece of legislation to allow health insurance to be sold across state lines.
Tillis echoed that sentiment, saying it would require “a commitment” to fill in “gaps” left by passing the Senate version, known officially as the Better Care Reconciliation Act.
“I think that there will be gaps that we’ll have to fill,” Tillis said. “We have a gaping hole in terms of the current policy. ... We simply can’t, I’m convinced, chip around the edges or trim around the edges.”
But Republicans need only look across the aisle to see what could happen to future plans. Democrats lost their majorities in the House and Senate after passing the Affordable Care Act and never got an opportunity to make fixes to the law, leaving Obama to stymie Republican efforts to get rid of the legislation.
Tillis said he has been working with state legislative leaders to make sure the Senate bill meets North Carolina’s needs and fits with state policy, including a plan to revamp Medicaid spending. State lawmakers passed a Medicaid overhaul in 2015, but they need federal permission to implement the changes.
“(Legislative leaders) know that thematically what we’re proposing in terms of state waivers and moving along with Medicaid reforms that we already started putting in place when I was serving down there, that it’s consistent with where they want to go anyway,” said Tillis, who served as North Carolina state House speaker from 2011 to 2014.
North Carolina is one of 19 states that did not expand Medicaid after passage of the Affordable Care Act, also known as Obamacare. Medicaid covers 1.9 million North Carolina residents, particularly low-income children and their parents and disabled people. The federal government pays about two-thirds of the $15 billion annual cost, but the state administers the program.
The bill could funnel money to the states in block grants or on a per-person basis rather than its current open-ended version. Medicaid spending would be cut by 26 percent by 2026 and by 35 percent by 2036 as compared to its current projection, according to the Congressional Budget Office.
One study, commissioned by the liberal Center for American Progress, found that 1.3 million fewer North Carolina residents could have health insurance under the first version of the Senate bill than under current law, with districts around Charlotte and Wilmington being among the hardest hit in the nation. A study by the Kaiser Family Foundation found that premiums in North Carolina could rise by 109 percent.
But North Carolina Senate leader Phil Berger said the effects of Obamacare have been devastating to the state and said ending it would be good policy.
“Obamacare dramatically increased health insurance premium costs for North Carolinians and generated hundreds of millions of dollars in unfunded Washington spending mandates that diverted our state’s tax dollars from priorities like increasing teacher pay,” Berger, an Eden Republican, said in a statement. “It is far too early in the process to comment on how the final Obamacare repeal bill might impact the state budget, but ending the catastrophic Washington takeover of health care is good policy.”