Senate Republicans released their long-awaited health care proposal Thursday morning, igniting a scramble for the 50 votes needed to satisfy their promise to repeal and replace former President Barack Obama’s signature health care bill.
Though four conservative Republicans announced they could not support the draft legislation “as written,” Sen. Richard Burr quickly issued a supportive statement. The North Carolina Republican said the 142-page proposal known as the Better Care Reconciliation Act of 2017 would provide “relief from the broken promises, high costs and few choices created by Obamacare.”
North Carolina’s other senator, Thom Tillis, didn’t take a position on the Senate proposal Thursday.
“This draft legislation outlines a number of initiatives that are good for North Carolina. While not perfect, the bill does provide the funding we need to support our most vulnerable North Carolinians,” Burr’s statement said.
Burr praised the bill for protecting people with pre-existing conditions and allowing children to remain on their parents’ insurance through age 26, both provisions originally implemented by Obama’s Affordable Care Act. He touted $2 billion in funding aimed at curbing opioid abuse, as well as money for community health centers.
The legislation builds upon the House’s American Health Care Act, which passed along party lines on May 4. All 10 Republican members of North Carolina’s delegation voted for the bill, while the delegation’s three Democratic representatives voted against it.
Burr said the bill would strengthen North Carolina’s Medicaid program, even as critics focused on the deep cuts the Senate bill would make in the government health insurance program for poor, elderly and disabled people. The cuts to Medicaid are deeper even than the $834 billion proposed in the AHCA, a bill that President Donald Trump reportedly called “mean.” Senate Minority Leader Chuck Schumer, a New York Democrat, called the Senate proposal “meaner.”
“We were hoping it would be an improvement. We don’t see this as an improvement,” said Julie Henry, spokeswoman for the North Carolina Hospital Association. “We’re very disappointed in this version. The thing that is difficult for a lot of people to see — there are lots of things that are key buzzwords and phrases and repealing a lot of the requirements of the Affordable Care Act — is how much of a burden it pushes to the state.”
North Carolina has roughly 2 million people on Medicaid, according to Henry, a figure in line with the national percentage of 20 percent, according to the Kaiser Family Foundation. The state did not expand Medicaid eligibility, which was one way Obamacare expanded coverage to millions of uninsured.
The bill changes Medicaid from an open-ended entitlement to one that puts a limit on per-patient spending beginning in 2021.
Henry said the bill would lead to more patients using the emergency room for health care.
“We don’t have the bandwidth to go back to where we were before with people coming into the emergency department without health insurance,” said Henry, whose organization represents 130 hospitals across the state.
“The design of the plan will likely result in higher health care costs for older and sicker patients. It also undermines the progress North Carolina has made when it comes to dealing with the growing number of people with Alzheimer’s and age-related dementia, as well as the state’s ability to provide care for our most vulnerable children and older adults,” said Steve Hahn, state director of AARP North Carolina.
Democrats remain opposed to radical changes to the Affordable Care Act, though many have said the law needs subtle changes.
“Senate Republicans cannot credibly claim to their constituents that this proposal will provide affordable coverage or improve quality of care,” said Rep. David Price, a Chapel Hill Democrat.
Said Wayne Goodwin, the chairman of the North Carolina Democratic Party and a former state insurance commissioner, “This is a cruel bill that makes dangerous, life-threatening cuts to Medicaid, undermines protections for those with pre-existing conditions, and makes it harder for millions more to afford basic health insurance. If Senators Burr and Tillis vote for this dangerous bill, they will have to answer to the people of North Carolina.”
Tillis is up for re-election in 2020. Burr, who was re-elected in 2016, has said this term will be his last.
Tillis issued a statement saying that “any replacement plan must be a net improvement over Obamacare” and that he looked “forward to carefully reviewing the draft legislation over the next several days.” In a 17-second video released on Twitter on Wednesday, Tillis indicated his confidence that Republicans would provide “a solution to the American people, one that makes sense, that gives you choices, that gives you the safety net that you need.”
Senate Republicans hold 52 seats in the Senate and, without any Democrats expected to support the legislation, can afford to lose only two members. Both Republican conservatives and moderates have expressed reservations about the legislation, with conservatives worried that it doesn’t do enough to dismantle Obamacare and moderates worried about quick, drastic changes that could leave residents vulnerable or without insurance.
The Congressional Budget Office is expected to issue a report on the legislation early next week, putting a number to how many Americans may lose their insurance under the bill and how much money the bill saves compared to current law.
Senate leaders hope to vote on health care by June 30.
Brian Murphy: 202-383-6089, @MurphinDC