Senate GOP weighs healthcare bill revisions that would tweak tax breaks, health plan regulations

Ted Cruz
GOP Sen. Ted Cruz is floating a proposal that would get the Senate's healthcare bill closer to the type of legislation conservatives have envisioned. (Gage Skidmore/CC BY-SA 2.0)

Senate GOP leaders, toiling in the final hours before their July 4 recess to find ways to improve their healthcare bill, are weighing several ideas that may or may not get them to their goal of 50 votes.

One such idea is championed by Sen. Ted Cruz, R-Texas, who is pushing for an amendment that would get the bill closer to the full Affordable Care Act repeal that conservatives crave. The idea, Vox explained, is to allow insurers to offer non-ACA-compliant plans in any given state as long as they offer at least one ACA-compliant plan in that state.

The upshot of such a policy is that it would essentially turn the exchanges into a high-risk pool, as sicker individuals would all flock to the more robust ACA-compliant plans, the article said. As an answer to that dilemma, though, Cruz noted that the ACA subsidies that the Senate bill largely preserves, along with the market stabilization fund it sets up, would help mitigate the effects of likely premium increases.

Senate Majority Leader Mitch McConnell is seriously considering Cruz’s idea, according to the Washington Examiner, though other Republicans have expressed some concern about it.

"It has to be structured in a way that ensures the (risk) pools are not adversely affected," Sen. John Thune, R-S.D., the third-ranking Republican in the Senate, told the publication.

Another idea making the rounds is one offered up by Sen. Bob Corker, R-Tenn., according to the Associated Press. Under his proposal, the Senate bill would retain the 3.8% tax increase on investments by higher earners implemented by the Obama administration, which would save $172 billion over 10 years. Moderate Republicans want to use those savings to provide more generous subsidies for low-earners in the Senate’s healthcare bill.

As they mull those options, Senate leaders have already offered up $45 billion to combat opioid abuse as a sweetener for GOP moderates who are reluctant to support the Better Care Reconciliation Act, Politico reported. However, at least one such moderate—Sen. Shelley Moore Capito, R-W.Va.—indicated that funding wouldn’t be enough to win her vote. She’d like to see it combined with more generous Medicaid provisions, according to the article.

Underscoring how much of a sticking point Medicaid continues to be, the Congressional Budget Office on Thursday released a new analysis estimating the Senate bill would cut Medicaid spending by 35% in two decades.

President Donald Trump, meanwhile, suggested in a tweet on Friday that Republicans may want to return to the "repeal-then-replace" idea that the party had considered before settling on its current strategy.