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The latest news on Obamacare from Business Insider

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    mitch mcconnell donald trump paul ryan

    Senate Majority Leader Mitch McConnell is staring down a wild week that could make or break the Republican attempt to repeal and replace Obamacare.

    To secure a vote on the Senate's healthcare legislation before the week-long July 4 recess, McConnell will have to make changes to the bill, swallow what is expected to be a rough score from the Congressional Budget Office, fend off criticism from Democrats and outside groups, and convince holdouts from either side of his conference to get on board.

    Chris Krueger, an analyst at Cowen Washington Research Group, painted the situation in stark terms in a note to clients on Monday.

    "This could be the most consequential week of the Trump Presidency thus far on Capitol Hill," Krueger said.

    With almost every other agenda item "bottle-necked behind healthcare," as Krueger put it, the pressure is on for McConnell to deliver.

    Fast process

    The CBO said it would release its score for the bill, the Better Care Reconciliation Act (BCRA), sometime early in the week. Reports suggested the score would come Monday afternoon.

    Experts predict that the score will show somewhere between 15 million to 22 million fewer Americans would be insured in 2026 under the BCRA than under the current baseline, according to a Politico survey.

    While the coverage losses would be a key rallying point for political opponents of the bill, the procedural key will come in its effect on the federal deficit. Based on the rules for the budget reconciliation process the GOP Senate is using to try to pass the bill, the BCRA has to decrease the federal deficit by at least the same amount as the House version, $133 billion, over 10 years.

    If that is the case, it would clear the way for McConnell to call for a vote on the bill, which triggers 20 hours of debate. That could come as soon as Tuesday, but could be pushed to Wednesday if Republican leaders want to tweak the bill to win over holdouts.

    Next would come a "vote-a-rama," which allows senators to introduce any number of amendments. That would allow Democrats to stall with a series of symbolic votes, but it is unlikely any of them will be adopted.

    Following the vote-a-rama, the vote on the full bill would come either Thursday or Friday.

    Big consequences

    McConnell and the GOP leadership can only afford to lose two votes on the bill in order for it to pass.

    As of now, five Republican senators hav come out against the bill. Four are conservatives who think the bill does not go far enough in repealing Obamacare's regulations — Sens. Rand Paul, Mike Lee, Ted Cruz, and Ron Johnson — while one is a more moderate voice that wants to preserve Obamacare's Medicaid expansion — Sen. Dean Heller of Nevada.

    More moderate senators who haven't indicated their preference are Sens. Susan Collins of Maine, Shelley Moore Capito of West Virginia, Lisa Murkowski of Alaska, Rob Portman of Ohio, and Bill Cassidy of Louisiana. With varying opinions from the GOP conference, finding changes that satisfy both wings of the party could prove difficult.

    "A handful of senators aren't ready to vote yet on health reform — they actually want to read the bill — so it's looking less likely that Mitch McConnell can get his floor vote late this week, before the July 4 recess begins," Greg Valliere, chief strategist at Horizon Investments, said in a note to clients on Monday.

    Issac Boltansky and Lukas Davaz, analysts at the political research firm Compass Point, said the Senate is less likely to pass the bill than the House.

    "The House health care bill passed in part because of a belief that the Senate would meaningfully rework the measure," Boltansky and Davaz said in a note. "With a conference committee as the next step in the legislative process, our sense is that undecided GOP senators will remain guarded against calls to support BCRA solely for the sake of legislative progress."

    The White House also seems to be supplying little by way of message support. In an interview that aired Sunday, Trump appeared to confirm that he referred the House's healthcare bill, which the Senate version closely resembles, as "mean."

    "The lack of policy coordination between the GOP Congress and White House remains baffling," Krueger said in a note.

    Valliere has the odds of passage before July 4 "a little below 50%," and Boltansky and Davaz peg it at roughly 30% due to the "the numerous political and procedural hurdles."

    Given that much of the GOP agenda is staked on getting healthcare done, a loss here for McConnell and Republicans could be damaging. But if they are able to get it done, the rest of the Trump agenda could click into place, with tax cuts and regulatory reform following.

    "Of course, this can all end in a raging political dumpster fire in the next 100 hours and is dependent on corralling 50 Republican senators on a less-than-popular bill," Krueger concluded. "But, there is a path for this super bull case to continue the momentum from four special elections."

    SEE ALSO: Even if the Senate healthcare bill passes, it's headed straight for a wall

    Join the conversation about this story »

    NOW WATCH: 'Where is Sean?': Things got awkward when April Ryan asked Sarah Sanders why Spicer didn’t attend the WH briefing


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    donald trump

    President Donald Trump took to Twitter Monday morning with a threat: Republicans might just let the Affordable Care Act "crash and burn" if Democrats don't work with the GOP on healthcare.

    "Republican Senators are working very hard to get there, with no help from the Democrats,"Trump tweeted."Not easy! Perhaps just let OCare crash & burn!"

    The tweet comes as the Senate is expected to vote this week on the Republican leadership's healthcare bill, known as the Better Care Reconciliation Act (BCRA).

    No Democrat is expected to vote for the bill and five Republican senators have already come out and said they will not support the legislation in its current form. Since only two Republicans can defect in order for the BCRA to pass, the biggest obstacle for Senate Majority Leader Mitch McConnell is getting his own party's members on board.

    Trump has consistently floated the idea of letting Obamacare's individual insurance exchanges "collapse" as a back-up plan if a Republican healthcare bill does not pass. His administration has also introduced a higher level of uncertainty around critical market stabilization measures that has already led to insurer exits and higher premium increase requests for 2018 than there would have been otherwise.

    Trump's team offered a tempered endorsement of the BCRA at the end of the week, with Trump saying that the bill needs a "little negotiation."

    But the BCRA gets to the heart of one of Trump's campaign promises: to not cut Medicaid. The BCRA would reduce the current path of Medicaid funding by billions of dollars over the next 10 years, though Trump surrogates argued over the weekend that the decrease in funding growth are not cuts.

    The Congressional Budget Office is expected to release a score for the BCRA on Monday, and a vote on the bill could come as early as Thursday.

    SEE ALSO: Even if the Senate healthcare bill passes, it's headed straight for a wall

    Join the conversation about this story »

    NOW WATCH: Listen to the leaked audio of Australia's prime minister mocking Trump


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    Ron Johnson

    Wisconsin Republican Sen. Ron Johnson published an op-ed in The New York Times on Monday outlining his criticism of Senate Republicans' proposed healthcare bill.

    Johnson argued that the legislation, drafted behind closed doors largely by Senate Majority Leader Mitch McConnell, "doesn't appear to come close" to fixing problems he says were caused by the regulations and reforms instituted by the Affordable Care Act, President Barack Obama's signature healthcare legislation.

    Johnson, who ran in 2010 on his opposition to Obamacare, did not go into much detail about how he would like the GOP bill to change, arguing that the solution to rising healthcare costs and millions of uninsured Americans is "simple."

    "A simple solution is obvious," he wrote. "Loosen up regulations and mandates, so that Americans can choose to purchase insurance that suits their needs and that they can afford."

    Johnson said that the current version of the repeal bill continues throw money at the problem, rather than rely on "consumer-driven, free-market competition" to lower costs and increase choice.

    "The bill's defenders will say it repeals Obamacare's taxes and reduces Medicaid spending growth. That's true," Johnson wrote of the GOP's proposal. "But it also boosts spending on subsidies, and it leaves in place the pre-existing-condition rules that drive up the cost of insurance for everyone."

    On NBC's Meet the Press on Sunday, the senator said there's "no way" the Senate should hold a vote on the bill, the details of which were released last Thursday, this week.

    "I have a hard time believing Wisconsin constituents or even myself will have enough time to properly evaluate this for me to vote for motion to proceed," Johnson said.

    Johnson is joined by nine other Republican senators who have voiced opposition to or concern about the current proposal. Ted Cruz (Tex.), Dean Heller (Nev.), Mike Lee (Utah), and Rand Paul (Ky.) have all announced they will not vote for the bill. Shelley Moore Capito (W.Va.), Bill Cassidy (La.), Susan Collins (Maine), Lisa Murkowski (Alaska), and Rob Portman (Ohio) have all voiced concerns.

    Read the full op-ed at The New York Times >

    Join the conversation about this story »

    NOW WATCH: 'I'll ask it one more time': Kellyanne Conway won't say whether Trump thinks climate change is a hoax


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    mitch mcconnell donald trump paul ryan

    Senate Republicans on Monday released an updated version of their plan to repeal and replace the Affordable Care Act.

    The legislation — called the Better Care Reconciliation Act of 2017 — debuted on June 22. The bill proposes rolling back much of the ACA, the healthcare law better known as Obamacare, including various tax provisions.

    The revised version of the bill includes a provision that's meant to replace the individual mandate by punishing people whose insurance has lapsed, locking them out of coverage for six months.

    The revision closes a loophole in the original bill that could have hurt the health insurance market. To avoid adverse selection in the individual insurance market, there needs to be a continuous-coverage provision to keep healthy people buying insurance instead of waiting until they're sick to do so.

    Healthier people paying into the pool helps ensure that costs for everyone stay lower. To make sure the market isn't full of sick people — resulting in higher costs and financial losses for insurers — there needs to be some reason for healthy people to sign up. The most effective way to do so is by having the carrot of coverage benefits and the stick punishing those who do not have coverage.

    Under Obamacare, this stick was the tax penalty for not having coverage. In the House Republicans' bill, people who did not maintain coverage the year before could have their premiums raised by as much as 30% as a penalty.

    According to Larry Levitt, a senior vice president at the Kaiser Family Foundation, a nonpartisan health-policy think tank, the new provision may not work as intended.

    "I doubt this encourages many healthy people to sign up," Levitt tweeted on Monday after the changes were announced. "That requires a lot of foresight among people not very focused on insurance."

    The bill also tweaks some of the language in Section 106, which discusses stability-program funding for states.

    What else is in the BCRA

    The legislation proposes scaling back funding that goes toward health coverage for low-income Americans and tax credits for middle-income earners who purchase their own health insurance.

    The plan would also provide funding designed to help stabilize the Obamacare insurance markets in the near term and funnel money through programs to cut off access to funding for abortion providers.

    The Senate legislation contains key differences from the American Health Care Act, the House GOP's legislation to dismantle Obamacare. The disparities could be sticking points if the two chambers have to compromise on the bill, which they would have to do before it could reach President Donald Trump's desk.

    But first, the legislation faces an uncertain future in the Senate, as it faces some pushback from conservative members who think it may not go far enough in repealing Obamacare and moderates concerned about its slashing of Medicaid spending. Like the House legislation, it could be subject to significant changes to get the needed number of votes.

    Senate Majority Leader Mitch McConnell is pushing for a vote by the end of the week, in part to avoid further public scrutiny of the bill over the weeklong July 4 recess. Similar scrutiny periled the original version of the House legislation. McConnell can afford to lose just two members of his conference for the bill to pass.

    Here's a rundown of the key provisions that were already in the bill:

    • Tax credits:
      • What's in the bill: To help people pay for insurance, the Senate bill proposes tax credits based on income level, a feature of Obamacare, rather than on age, as the House bill calls for. The bill would make anyone earning up to 350% of the federal poverty level eligible for credits; Obamacare caps that at 400%. It would, however, adjust the credits to be less generous as a person ages. For instance, a 33-year-old making 175% of the federal poverty level would receive enough in credits so they spend 5.3% of their income on premiums. For people over 59, that would increase to 8.3%. Additionally, the credits would be capped at a lower percentage of overall medical costs than those under Obamacare, making them less generous overall.
      • What it means: While the tax credits would be more generous for older Americans than the tax credits in the House bill, fewer middle-income people would get financial support to pay for coverage — and those who did would get less.
    • Medicaid expansion:
      • What's in the bill: Obamacare's Medicaid expansion, which extended the program to those making 100% to 138% of the federal poverty level, would be phased out over four years — 90% of the current federal funding would be provided in 2020, decreasing by 5% each year until 2023, after which it would be eliminated. People would not be allowed to join the expansion from 2020 onward. The tax credits would be available to people who fell off the expansion.
      • What it means: While this would save the federal government money, it would also mean the millions of people who have gained access to Medicaid would be rolled off. These people would be able to fall back on the less generous tax credits and access coverage through the individual insurance market.
    • Medicaid spending growth:
      • What's in the bill: The Senate bill retains the House's per capita cap for federal Medicaid spending. After 2025, however, growth in spending would shift from being tied to the consumer price index for medical care to the CPI for all goods, a lower level of growth.
      • What it means: States would receive less funding each year from the federal government to help cover low-income Americans, and after 2025 the rate of growth would decline, possibly leading to even deeper cuts to the program.
    • States can institute Medicaid work requirements:
      • What's in the bill: This would allow states to create a provision under which people must maintain employment, as the state defines, for a period, also determined by the state, for a person to receive Medicaid.
      • What it means: This is another longtime wish for Republicans, but it would also give states significant leeway to define what counts as work and how long someone has to hold a job to be eligible. It would not apply to students, pregnant women, or people with disabilities.
    • Cost-sharing subsidies:
      • What's in the bill: The bill would allocate money for cost-sharing subsidies through 2019. These payments offset the costs for insurers to offer low-income Americans plans with smaller out-of-pocket costs. The uncertainty around these payments has led to instability in the individual insurance market.
      • What it means: This should reassure insurers desperate for guidance ahead of the 2018 plan year and could bring down premium increases for the individual insurance market.
    • State waivers for Obamacare regulations:
      • What's in the bill: The Senate bill would allow states to request a waiver to opt out of Obamacare's so-called essential health benefits, which mandate that all plans must cover 10 basic types of care. The ability to opt out of providing those benefits was a sticking point in the House legislation, and its inclusion ultimately allowed it to pass. The Senate bill, however, would not allow states to repeal community rating, the provision mandating that all people of the same age in the same area be charged the same amount. That's a change from the House bill, which drew criticism from health-policy experts who said a repeal of community rating would allow insurers to charge people with preexisting conditions more.
      • What it means: If a state were to receive a waiver for the benefits, it would allow for skimpier coverage offerings on its insurance market that would have cheaper premiums but higher out-of-pocket costs.
    • Repeal Obamacare's taxes:
      • What's in the bill: Much like the House version, the Senate bill would do away with things like Obamacare's 3.8% tax on investment income on people earning more than $200,000 annually.
      • What it means: The taxes in Obamacare fall predominantly on a small percentage of wealthy Americans who would see their tax bills decrease under the Senate bill. For instance, the Republican megadonor and casino magnate Sheldon Adelson could have his 2017 tax bill cut by roughly $44 million.
    • A fund to provide grants to fight the opioid crisis:
      • What's in the bill: The bill would establish a $2 billion fund for states for programs to "support substance use disorder treatment and recovery support services for individuals with mental or substance use disorders."
      • What it means: This is a one-time fund for 2018, but it is likely to be favored by senators from states hit hard by the opioid crisis. It was a key ask from Ohio Sen. Rob Portman.
    • No funds can be used for abortions:
      • What's in the bill: No plan purchased using funding from the bill could cover abortions. Additionally, none of the funds allocated by the bill could be given to healthcare providers that offer abortion services.
      • What it means: In addition to restricting anyone who used the credits or other funds from getting plans that cover abortions, this would effectively defund Planned Parenthood. It is unclear if this provision will pass Senate rules.

    Here is the full updated bill:

    SEE ALSO: The one issue that could decide the fate of the Republican healthcare bill

    DON'T MISS: Medicaid cuts in the Senate healthcare bill are going to hit some states hard – here's who will feel it

    Join the conversation about this story »

    NOW WATCH: 'Where is Sean?': Things got awkward when April Ryan asked Sarah Sanders why Spicer didn’t attend the WH briefing


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    mitch mcconnell

    The Congressional Budget Office on Monday released its analysis of the Senate Republican healthcare bill, projecting significant coverage losses both immediately and over the next decade if the legislation were to become law.

    The CBO projected that 22 million fewer people would have coverage under the bill, the Better Care Reconciliation Act, in 2026 than under the current healthcare system.

    That is slightly below the CBO's projection last month that 23 million fewer people would have coverage under House Republicans' American Health Care Act. But the Senate bill would still push the number of uninsured up to 49 million in 2026 versus about 28 million under current law, the CBO said.

    The budget office also projected the bill would reduce the federal deficit by $321 billion between 2017 and 2026 — more than the projected $119 billion in savings under the House bill — meaning it can qualify for passage under Senate rules.

    The savings would be possible with an $862 billion cut in spending over that time, the CBO said, while revenue would decline by about $541 billion from tax cuts.

    Moderate GOP senators who have expressed concerns over large coverage losses may not be reassured by the score. Sen. Susan Collins of Maine, a key swing vote, said Thursday that coverage losses of the size estimated by the CBO score were not acceptable.

    "I cannot support a bill that's going to result in tens of millions of people losing their health insurance,"Collins said.

    Senate Majority Leader Mitch McConnell can lose only two members for the bill to pass. Five Republicans publicly came out against the bill in its draft form.

    Here are a few other key findings from the CBO:

    • Premiums would increase in 2018 and 2019 compared with the current baseline but decline after. According to the CBO, premiums would be 20% more than under current law in 2018 and 10% more in 2019. In 2020 and beyond, the change in the risk pool, with older and poorer Americans most likely priced out, would bring these premiums down.
    • Deductibles and out-of-pocket costs would increase substantially. The benchmark plan on the individual insurance market would have an actuarial value of 58%, meaning insurance would be obligated to cover 58% of total costs. That is down from the current 70% benchmark value. According to the CBO, that would open the door for higher deductibles and out-of-pocket costs.

      "Under current law for a single policyholder in 2017, the average deductible (for medical and drug expenses combined) is about $6,000 for a bronze plan and $3,600 for a silver plan," the CBO said, adding that it and the Joint Committee on Taxation "expect that the benchmark plans under this legislation would have high deductibles similar to those for the bronze plans offered under current law."
    • The newly added waiting-period provision would lead slightly more people to maintain coverage. The provision, added to the bill on Monday, would make anyone who did not maintain coverage in the prior year wait six months before being able to access coverage benefits if they signed up the following year.

      "Imposing that waiting period would, CBO and JCT expect, slightly increase the number of people with insurance, on net, throughout the 2018-2026 period — but not in 2019, when the incentives to obtain coverage would be weak because premiums would be relatively high," the CBO said.
    • Individual insurance markets would remain stable. The last version of the House healthcare bill would have made unstable the markets for people purchasing insurance not through an insurer or government program like Medicaid, the CBO said, but the Senate bill would not destabilize these markets.

    SEE ALSO: The Senate healthcare bill process 'could end in a raging political dumpster fire'

    Join the conversation about this story »

    NOW WATCH: Listen to the leaked audio of Australia's prime minister mocking Trump


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    Katie Walsh

    Last Friday, the White House-backed group America First Policies revealed a seven-figure ad campaign targeting a member of President Donald Trump's own party, Sen. Dean Heller of Nevada, who recently announced he would oppose the GOP's healthcare bill.

    The attack startled many Republicans, who think the threatening tactic lacks strategic value and belies a breakdown in communication between Congress and the White House.

    "Running ads targeting the most vulnerable Republican incumbent senator for not voting for a bill" that is is fairly unpopular "is one of the dumbest things that can be done by this group, or any group for that matter," Evan Siegfried, a Republican strategist and author of the book "GOP GPS," told Business Insider.

    Heller will likely face a tough reelection battle in 2018. Hillary Clinton won the state of Nevada in November, and the state expanded Medicaid under the Affordable Care Act, commonly known as Obamacare.

    In a tweet on Friday, America First Policies — which is run by former Trump campaign advisers — accused Heller of lying to his constituents.  

    Heller told reporters that he could not support a bill "that takes insurance away from tens of millions of Americans and hundreds of thousands of Nevadans" and fails to lower insurance premiums.

    Siegfried called the ad campaign, which will reportedly be rolled out this week, "reckless" and counterproductive, arguing that the move has likely delighted Democrats.

    "If they're going to attack the very people they need and end up hurting us to the point that it results in Democrats taking that seat, they'll have nobody to blame but themselves," he said, adding that the move is reflective of Trump's approach to Congress, which he said is to treat Republican lawmakers as "middlemen."

    Matt Mackowiak, a conservative consultant and president of Potomac Strategy Group, agreed that the attack plan will likely be unhelpful to Trump and the GOP, but noted that the strategy was not intended to be persuasive. Rather, the White House is attempting to send a signal to other Republicans who are on the fence about the bill.

    "It was about deterrence, not about persuasion," Mackowiak said.

    Some Republican operatives have also criticized the group for targeting one of Heller's legislative aides, Rachel Green, by including her Twitter handle in its tweets condemning Heller. 

    So far, five Republicans have said they will not vote for the bill in its current form, and five others have voiced concern about it.

    Mackowiak argued a conciliatory approach would likely be more effective, but noted that America First Policies might be making up for opportunities it missed during the House healthcare debate.

    "They were looking back at the House experience and saying I wish we'd done this then, let's do this now," Mackowiak said, adding that these kinds of outright attacks are often more effective against congressmembers, who are up for election more frequently than senators are.

    But Siegfried said that Trump is likely incapable of effectively persuading or pressuring GOP lawmakers.

    "The Trump mindset is to attack — they've never been able to encourage and cajole people into doing things," Siegfried said. "It was a carrot and stick situation without a carrot, and they went right to the stick."

    While Trump himself has not directly attacked Heller or other Republicans, he tweeted his displeasure with them last Saturday.

    Amid reports on Monday that America First Policies might rethink its planned attacks on Heller, following pressure from Republican leadership, the group tweeted on Monday afternoon that it "won't hold back."

    Erin Montgomery, a spokesperson for America First Policies, told the Washington Examiner on Monday that the group had never considered de-fanging its campaign against Heller. 

    "We were always making multiple creative ads in the event that Heller changed his mind, but we're not giving him a second chance," Montgomery said. "We are moving forward with ads regardless, we're not waiting on him to change his mind."

    The Associated Press reported on Monday that the group is expanding its campaign to include four other Republicans critical of the bill: Sen. Rand Paul of Kentucky, Sen. Ted Cruz of Texas, Sen. Mike Lee of Utah and Sen. Ron Johnson of Wisconsin. 

    Join the conversation about this story »

    NOW WATCH: Trump accidentally tweeted 'covfefe' — and Twitter immediately turned it into a huge meme


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    The Congressional Budget Office released its projections for the effects of the Senate Republican healthcare bill on Monday.

    The report showed how devastating some of the changes in the bill, called the Better Care Reconciliation Act (BCRA), could be for low-income and older Americans.

    According to the CBO, lower premium assistance through the BCRA would cause premiums for older and low-income Americans to increase significantly.

    For instance, under current law, a 64-year-old making $56,800 a year would see the premium of the current benchmark silver-level plan increase from $6,800 annually to $20,500. That means premiums would eat up 36% of the person's total annual income, up from 12% now.

    Here's a breakdown in the premiums changes for the current benchmark silver-level plans under Obamacare and the BCRA:

    silver premiums v3

    Here's a breakdown for cheaper, less generous bronze plans:

    bronze premiums v3

    For people considering which plan to buy, under the BCRA, the actuarial value for each benchmark plan would be lower, the CBO said. The actuarial value is the percentage of healthcare costs that would be covered by the insurance company in a certain plan.

    According to the CBO, most low-income people would shift to plans with a actuarial value because they would likely have more comparable premiums to the current, higher actuarial value plans they currently have. Here's the CBO's example:

    "In a set of illustrative examples, CBO and JCT estimate that a 40-year-old with income at 175 percent of the [federal poverty line] in 2026 could pay a net premium of $1,700 for a silver plan under current law and $1,600 for a plan with actuarial value of 58 percent under this legislation. However, because the reference premium would be changed and cost-sharing subsidies would be eliminated under this legislation, the average share of the cost of medical services paid by the insurance purchased by that person would fall—from 87 percent to 58 percent—and his or her payments in the form of deductibles and other cost sharing would rise. Those changes, CBO and JCT estimate, would contribute significantly to a reduction in the number of lower-income people who would obtain coverage through the nongroup market under this legislation, compared with the number under current law."

    Put another way, with less financial help from the government, poorer Americans would trade down to less generous plans to keep their premiums roughly the same. These plans, however, would hit them with higher out-of-pocket costs that would eat up a good amount of their income.

    That would mean poorer Americans would be saddled with three choices: high-premium plans with decent coverage, plans that have manageable premiums but high out-of-pocket costs, or no insurance altogether.

    To put that all together, low-income Americans will either pay substantially more for the same care they have now — or pay the same amount for coverage that is significantly less generous. 

    SEE ALSO: The CBO says the Senate GOP healthcare bill would leave 22 million more without insurance

    Join the conversation about this story »

    NOW WATCH: 'I'll ask it one more time': Kellyanne Conway won't say whether Trump thinks climate change is a hoax


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    mcconnell trump paul ryan

    The Senate Republican healthcare bill teetered on the brink of collapse on Tuesday morning, just a few days after it was unveiled and the morning after the Congressional Budget Office delivered a brutal assessment of its potential effects on coverage.

    Sen. Susan Collins of Maine, a key moderate vote in the Republican conference, tweeted on Monday night that given its potential effects, she would not vote for the legislation — or even a motion to move it forward on the Senate floor.

    "I want to work w/ my GOP & Dem colleagues to fix the flaws in ACA. CBO analysis shows Senate bill won't do it," Collins tweeted Monday, adding that she would "vote no" on a motion to proceed.

    Other members of the GOP Senate conference also appear to be on the fence about voting for the legislation, officially named the Better Care Reconciliation Act. Many of them wavered after an analysis from the nonpartisan CBO released Monday predicted that the BCRA would reduce the number of insured Americans by 22 million in 2026 compared with the current baseline.

    Sen. Ron Johnson, of Wisconsin, one of four conservatives who came out against the legislation when it was released last week, also said on Monday that he had"a hard time believing I'll have enough information for me to support a motion to proceed this week."

    A representative for Sen. Mike Lee, another conservative holdout, told The New York Times on Monday that the senator would not vote for the legislation as written.

    Collins and Johnson joined Sens. Dean Heller and Rand Paul, who previously announced their opposition to a motion-to-proceed vote for the bill. Any more than two votes by GOP members against the motion would defeat it, as Senate Democrats universally oppose it.

    Heller is up for reelection in 2018 in Nevada, a state that Hillary Clinton won and that has a popular GOP governor who opposes the BCRA for its cuts to Medicaid. Heller on Friday announced his intention to vote against the legislation.

    In Paul, GOP leaders have the opposite problem, as the Kentucky senator believes the BCRA does not go far enough in its repeal of the Affordable Care Act, the healthcare law better known as Obamacare.

    On Monday, moderate Sen. Lisa Murkowski of Alaska said she had not gotten to a "yes" vote yet and wanted to learn more about the bill's potential effects on her state.

    "I don't have enough data in terms of the impact to my state to be able to vote in the affirmative," Murkowski told CNN's Dana Bash.

    Sen. Bill Cassidy of Louisiana also wavered after seeing the CBO score.

    "It makes me more concerned," Cassidy told CNN. "I've been uncommitted and I remain uncommitted — I mean just deadline uncommitted. But it certainly makes me more concerned and makes me want to explore this more."

    susan collins

    Republican leadership targeted a vote late Tuesday or early Wednesday on the motion to proceed to get a final vote by the end of the week. This plan would finish the process before the weeklong July 4 congressional recess.

    Senate GOP leadership had not given up hope as of Monday night, seeking to alleviate members’ concerns and at the very least clear the motion to proceed.

    "We're trying to accommodate their concerns without losing other support," Senate Majority Whip John Cornyn told reporters, adding the conference was in a "good place."

    The White House is also attempting to exert its influence on the process, with Vice President Mike Pence dining with conservative members of the caucus including Lee, who signed a letter opposing the bill on Thursday.

    President Donald Trump called Cruz, Johnson, Paul, and Sen. Shelley Moore Capito of West Virginia to ask for their support on the bill, according to the White House press secretary, Sean Spicer.

    But Trump himself has wavered over the past several weeks. In an interview that aired Sunday, he appeared to confirm to Fox News that he called the House's version of the healthcare bill "mean." His comments have been a constant point of attack for Democrats over the past week.

    The mix of members opposing the motion leaves leadership in a precarious position. If Senate leaders try to move the bill to the right by cutting more funding or repealing regulations to appease conservatives like Lee, Paul, and Johnson, they could further alienate Collins and Heller, as well as Murkowski and Capito.

    Move the bill to center with more generous funding, a smaller deficit reduction, and a slower phasing out of Obamacare's Medicaid expansion, and Lee, Johnson, Paul, and Cruz could block the vote.

    But as many longtime political observers suggested Monday, Senate Majority Leader Mitch McConnell would be as capable as anyone of brokering a deal that would placate both wings of the party.

    Still, a deal is "unlikely before the end of this week, when the July 4 break begins — it's not even certain a motion to proceed can pass today or tomorrow," said Greg Valliere, the chief strategist at Horizon Investments. "But McConnell now has an option — he can yank the bill this week, delaying a final vote until late July, giving him time for wheeling and dealing with individual members."

    SEE ALSO: The CBO says the Senate GOP healthcare bill would leave 22 million more without insurance

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    On Tuesday morning, Republican senators on the fence about voting for the GOP healthcare bill were met with local newspaper headlines screaming the dismal results of the Congressional Budget Office's Monday report on the bill's projected impact. 

    From North Carolina to Nevada, front pages featured the news that 22 million Americans would lose health insurance by 2026 and that Medicaid would be cut by nearly $800 billion under the proposed Obamacare-replacement law.

    In Maine, home to Republican Sen. Susan Collins, who has said she will vote against the current version of the bill, the Portland Press Herald's top headline read, "Older, rural Mainers hit hard by Senate's health care plan," while Lewiston's Sun Journal trumpeted Collins' opposition to the legislation with the headline, "Collins against GOP health bill."

    Other Maine newspapers also warned of the results of the CBO report.

    In Wisconsin, the Wausau Daily Herald's top story featured the effects of proposed Medicaid cuts on the state's education system. Its top headline read, "Caps in Medicaid could cost schools: health care bills push special needs expenses onto schools."

    Sen. Ron Johnson of Wisconsin suggested this week that he might not support the bill.

    Wausau Daily Herald

    The majority of the Charleston Gazette-Mail's front page on Tuesday featured photos of protesters outside the West Virginia offices of Republican Sen. Shelley Moore Capito, who has not announced her position on the bill.

    Charleston Gazette-Mail

    The White House has been pressuring Republicans to vote for the bill, but it's still unclear whether it has enough support to make it through the Senate.

    SEE ALSO: A White House-backed group is going after a Republican senator who refuses to support the GOP healthcare bill

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    The Congressional Budget Office on Monday released its report on the Senate Republican healthcare bill.

    The CBO estimated that the bill, Better Care Reconciliation Act (BCRA), would result in the 22 million fewer people with health insurance by 2026 compared to the current system. That would bring the total uninsured population in the US to 49 million people.

    total uninsured

    So, where do these coverage losses come from?

    Most, according to the CBO, would come from people rolling off Medicaid. The combination of repealing the Affordable Care Act's Medicaid expansion and lower federal funding for Medicaid would result in low-income Americans dropping off the rolls.

    According to the CBO, 15 million fewer people would be on Medicaid in 2026 compared to the current baseline.

    In 2026, the CBO also estimated that seven million fewer people who did not have access to coverage through their employer or a program like Medicaid would be without insurance.

    House Speaker Paul Ryan and other Republicans have suggested that would come from fewer people choosing to purchase insurance due to the elimination of the Obamacare's individual mandate.

    But while some, especially younger and more affluent people, would choose not to purchase insurance, the CBO estimated that many older and low-income Americans would not get coverage because it would be too expensive. Lower tax credits and a drop in the amount of costs insurers would be required to cover under the BCRA would leave poorer and elderly Americans with higher costs that could be prohibitive in buying insurance.

    The CBO also estimated that the repeal of the employer mandate under the BCRA would lead to businesses dropping healthcare benefits from employees and some employees forgoing healthcare benefits, leading to an increase in the uninsured population in the first few years the law would be enacted. A tighter labor market could reduce that predicted drop as employers increase their benefit packages to lure workers.

    sources of uninsured under BCRA

    SEE ALSO: The Senate Republican healthcare bill is collapsing

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    mitch mcconnell

    Senate Republican leaders announced unexpectedly on Tuesday afternoon that they would delay the body's vote on the GOP healthcare bill until after the July 4 recess, multiplenews outlets have confirmed.

    Senate Majority Leader Mitch McConnell's move to delay the vote came after key Republican senators came out against the draft bill following the nonpartisan Congressional Budget Office estimate that 22 million Americans would lose health insurance as a result of the legislation.

    At least five senators, from both conservative and moderate wings of the party, had publicly said they would not support a key procedural vote to allow the bill to advance to debate.

    Moderate members Susan Collins and Dean Heller said they would not vote to advance the bill because of concerns regarding the decreased funding for Medicaid and the dismal CBO score. Conservative Sens. Rand Paul, Ron Johnson, and Mike Lee also said they were against moving the bill because they did not believe it went far enough in its repeal of the Affordable Care Act, the healthcare law better known as Obamacare.

    Sen. Lisa Murkowsi, a key moderate vote from Alaska, told reporters she was happy with the decision to delay. "I think that was an important step," Murkowsi said "I certainly wasn't ready."

    The divisions made it difficult for McConnell to find a pathway to amend the bill and win over enough members to even get the bill to the floor debate.

    Multiple news outlets have reported that the Senate GOP leadership plans to rewrite the bill over the July 4 weeklong recess and resubmit it to the CBO for a new score. The large loss of coverage and high costs projected in the CBO report released Monday drew swift condemnation from healthcare groups and Democrats, and even some Republican members expressed concern.

    "We're not going to vote this week, so we have more time to work on it until we get it done," Senate Majority Whip John Cornyn, the second-highest ranking Senate Republican, told reporters.

    During a press briefing on Capitol Hill on Tuesday afternoon, McConnell called healthcare a "a big, complicated subject" and said he hoped to get "at least 50 people in a comfortable place" on the bill in the coming weeks. 

    McConnell originally hoped to be done with the bill before the recess to avoid prolonged public scrutiny similar to that faced by the House's American Health Care Act, which endured two false starts before passing in May.

    President Donald Trump has reportedly invited Republican senators to the White House on Tuesday at 4 p.m. ET to discuss the bill.

    Bob Bryan contributed to this report.

    SEE ALSO: The Senate Republican healthcare bill is collapsing

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    susan collins

    Senate GOP leaders decided to delay a vote on the party's healthcare bill on Tuesday until after the week-long July 4 recess. But the immediate reaction from one key senator made any change in fortune seem less than likely.

    Sen. Susan Collins, a moderate from Maine, told reporters that it would take more than just a few "tweaks" to get her on board with the bill.

    "I will say I have so many fundamental problems with the bill, that have been confirmed by the CBO report, that it's difficult for me to see how any tinkering is going to satisfy my fundamental and deep concerns about the impact of the bill," Collins said.

    The Congressional Budget Office projected that 22 million more Americans would be without health insurance under the bill, Better Care Reconciliation Act, than the current baseline. Additionally, low-income and older Americans would end up paying more for insurance, the CBO projected.

    For Senate Republican leaders, the worrying aspect of the Collins statement is that she wants structural changes to bill, which would be more likely to move it in a more moderate direction. But Senate Majority Leader Mitch McConnell moves the bill in that direction, he risks losing conservative members of his conference.

    On the other hand, if leaders try to court conservatives, they could lose other moderates. Sen. Dean Heller of Nevada, for instance, has already said he would oppose the bill in its current form.

    McConnell can only lose two votes for the bill to pass.

    The CBO score did contain one piece of good news for the leadership. The report projected that the bill would reduce the deficit by $331 billion over 10 years, over $200 billion more in savings than the House version. Since the Senate bill only has to save the same amount of the House bill for it to qualify under Senate rules, McConnell could use that difference to include incentives for individual senators.

    In addition to reiterating her opposition to the bill, Collins also criticized President Donald Trump's approach to the healthcare debate.

    "This president is the first president in our history who has had neither political nor military experience," Collins said. "Thus, it has been a challenge to him to learn how to interact with Congress and how to push his agenda forward. I also believe it would have been better had the president started with infrastructure, which has bipartisan support, rather than tackling a political divisive and technically complicated issue like healthcare."

    Collins said she would go to the White House along with the rest on the Senate GOP conference for a meeting with Trump on healthcare at 4 p.m. ET on Tuesday.

    SEE ALSO: The 9 GOP senators who will decide the fate of the Republican healthcare bill

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    The nonpartisan Congressional Budget Office estimates that 22 million Americans would lose their health insurance by 2026 under the Senate Republican healthcare bill.

    As Bobby Kogan of the liberal Center for American Progress tweeted on Monday, that number is equal to the residents of the 16 smallest states (by population) and Washington, DC, combined.

    Senate Republican leaders announced unexpectedly on Tuesday — after key Republican senators came out against the draft bill — that they would delay the body's vote on the bill until after the July 4 recess.

    pop vs uninsured

    SEE ALSO: Senate Republicans delay vote on healthcare bill until after July 4 recess

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    Several Republican senators voiced their opposition to the Senate healthcare bill just hours after the GOP leadership said they would delay a vote on the legislation until after the July 4 recess.

    Senate Majority Leader Mitch McConnell and other leaders will look to come to an agreement with members on a revised bill by the end of the week. By most indications, that will be difficult.

    After the delay, Republican senators went on record opposing the current iteration of the bill, the Better Care Reconciliation Act (BCRA). Combined with those that defected before the delay, at least nine GOP senators have said they opposed the first iteration of the bill.

    Here's a rundown of all of the public GOP dissenters:

    • Rand Paul of Kentucky: Released a statement with three other conservative senators on Thursday opposing the bill, saying it did not do enough to repeal Obamacare's regulations and decrease the deficit.
    • Ted Cruz of Texas: Signed onto the statement opposing on Thursday. Cruz applauded the decision to delay the vote, but said there are still productive conversations going on about the bill.
    • Ron Johnson of Wisconsin: One of the signees to the statement on Thursday with Cruz and Paul. "I'm pleased Senate leadership has agreed to give us more time to analyze the health care bill. A vote this week would have been rushed, and I look forward to taking time in the coming days to improve this bill," Johnson said in a statement after the delay.
    • Mike Lee of Utah: Another of the four conservative signees on Thursday.
    • Dean Heller of Nevada: Up for reelection in Nevada in 2018 in a state won by Hillary Clinton in the presidential election. He opposed the cuts to Medicaid and said the draft bill would not lower people's premiums.
    • Susan Collins of Maine: Said she has "fundamental issues" with the current draft of the bill. "I will say I have so many fundamental problems with the bill, that have been confirmed by the CBO report, that it's difficult for me to see how any tinkering is going to satisfy my fundamental and deep concerns about the impact of the bill," Collins said.
    • Jerry Moran of Kansas: Moran, a relatively middle-of-the-road member, said the process was simply moving too fast. "The Senate healthcare bill missed the mark for Kansans and therefore did not have my support," Moran said Tuesday. "I am pleased with the decision to delay the vote — now is the time to take a step back and put the full legislative process to work."
    • Shelley Moore Capito of West Virginia: West Virginia has the largest population of Medicaid recipients, so Capito wants to secure more funding for the program. "As drafted, this bill will not ensure access to affordable health care in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply, and harms rural health care providers," Capito said in a statement.
    • Rob Portman of Ohio: Wants to ensure more funding for Medicaid and to fight the opioid crisis in the bill. "Unfortunately, the Senate draft falls short and therefore I cannot support it in its current form," Portman said in a statement. "In the days and weeks ahead, I’m committed to continue talking with my colleagues about how we can fix the serious problems in our health care system while protecting Ohio's most vulnerable citizens."

    McConnell can only afford to lose two votes on the bill for it to pass.

    SEE ALSO: A key GOP senator gave an ominous warning for the future of the Senate Republican healthcare bill

    DON'T MISS: Senate Republicans delay a vote on their healthcare bill until after July 3

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    susan collins donald trump lisa murkowski

    President Donald Trump conceded on Tuesday that the current Republican bid to repeal and replace Obamacare may not succeed.

    Trump met with Republican senators just hours after Majority Leader Mitch McConnell delayed a vote on the party's healthcare bill, saying that if it doesn't pass he would "understand."

    "This will be great if we get it done," Trump said. "And if we don't get it done, it's just going to be something that we're not going to like. And that's okay, and I understand that very well."

    Trump said, however, that the GOP is "getting very close" on passing the bill. But he did open the door to the possibility that healthcare overhaul may not happen.

    Currently, there are nine Republican senators who have publicly opposed this iteration of the Better Care Reconciliation Act. Only two can vote against it for the bill to succeed.

    Republican opposition to the bill has come from both the conservative and moderate wings of the conference, making a compromise difficult.

    Trump was surrounded during the White House meeting by more moderate senators that have expressed doubts about the BCRA, including Susan Collins of Maine, Dean Heller of Nevada, and Lisa Murkowski of Alaska.

    SEE ALSO: GOP senators come out in furious force against healthcare bill after vote delayed

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    warren buffett

    Warren Buffett thinks the Republican healthcare bill has one goal: to help rich people like him.

    During an interview with "PBS NewsHour" on Tuesday, the legendary investor presented his tax return from last year to show just how much he would save from the two proposed Republican plans (the House's American Health Care Act and the Senate's Better Care Reconciliation Act).

    "Well, I brought my tax return along for the last year," Buffett told PBS' Judy Woodruff. "I filed this on April 15. And if the Republican — well, if the bill that passed the House with 217 votes had been in effect this year, I would have saved — I can give you the exact figure. I would have saved $679,999, or over 17% of my tax bill."

    Both the House and Senate GOP bills repeal all of the taxes created by the Affordable Care Act, or Obamacare, which primarily fall on the wealthiest Americans. According to a study by the Tax Policy Center, the top 1% of earners in the US would see an average tax-bill decrease of $37,240 under the proposed healthcare bills. People in the top fifth of earners would get 64.2% of the benefit from the tax cut.

    "There's nothing ambiguous about that," Buffett said. "I will be given a 17% tax cut. And the people it's directed at are couples with $250,000 or more of income. You could entitle this, you know, Relief for the Rich Act or something, because it — I have got friends where it would have saved them as much as — it gets into the $10-million-and-up figure."

    Buffett also criticized Republicans for voting for a bill that would bring down their own taxes, saying most members of Congress make more than $250,000 a year.

    "They have given themselves a big, big tax cut, if they — if they voted for this," the Berkshire Hathaway CEO said.

    Buffett also reiterated his call for a single-payer system for healthcare, which he said would be "more effective."

    You can watch the exchange below:

    SEE ALSO: Trump admits that Senate Republicans may not pass Obamacare repeal bill, 'and that's okay'

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    dean heller susan collins donald trump

    President Donald Trump made the pledge to repeal and replace Obamacare one of the key issues of his 2016 election campaign. But as Republicans try in earnest to make good on that promise, Trump appears to be losing influence.

    Senate Majority Leader Mitch McConnell said Tuesday that GOP leadership would delay a vote on its healthcare bill, the Better Care Reconciliation Act, until after the weeklong July 4 recess because of a lack of support among Republican lawmakers.

    Nine members of the party have publicly said they would not vote for the bill in its current form. McConnell can lose only two votes for the BCRA to pass, as all Democrats are expected to oppose it.

    But Trump apparently isn't helping GOP members get to "yes." In contrast to his hard sell on the House healthcare bill, The Washington Post and The New York Times published reports late Tuesday saying Trump had done little to get the reluctant GOP senators to come to an agreement.

    According to The Times' Glenn Thrush and Jonathan Martin, Trump has been "on the sidelines" during the Senate negotiations.

    In fact, one Republican senator in favor of the BCRA told The Times that the president "did not have a grasp of some basic elements of the Senate plan" during a meeting with all of the GOP members on Tuesday. The senator also said Trump was confused when a moderate expressed concern that the bill would be seen as a tax break for the rich.

    A Tax Policy Center analysis showed that the top 0.1% of earners in America would receive, on average, a $207,390 tax break from the BCRA.

    The Times also reported that Republican senators, including McConnell, expressed frustration with ads from a pro-Trump nonprofit group attacking GOP Sen. Dean Heller for going against the BCRA. Heller is up for reelection in Nevada come 2018 and faces an uphill battle in a state Democrat Hillary Clinton won in last year's presidential election.

    A senior Republican close to both the Senate and the White House also told The Post that Republican lawmakers thought Trump was a "paper tiger" and did not mind going "their own way."

    The lack of deference, according to The Post, comes from a feeling among lawmakers that Trump lacks an understanding of policy and that his low approval numbers do not give him much political capital.

    "Trump doesn't bring us any votes. He just doesn't," a source close to McConnell told Politico.

    Donald Trump

    Sen. Susan Collins, a moderate GOP holdout on the Senate legislation, also criticized Trump's approach to the process while talking with reporters on Tuesday after the delay was announced.

    "This president is the first president in our history who has had neither political nor military experience,"Collins said. "Thus, it has been a challenge to him to learn how to interact with Congress and how to push his agenda forward. I also believe it would have been better had the president started with infrastructure, which has bipartisan support, rather than tackling a political divisive and technically complicated issue like healthcare."

    Lawmakers were already wary of Trump's turnaround on the House bill. In just a few weeks, the president went from a White House Rose Garden ceremony celebrating the bill's passage to calling the bill "mean" during a private meeting with senators. Trump last weekend confirmed in a national TV interview that he called the bill "mean."

    Trump's comments have become a rallying point for Democrats' attacks on the GOP healthcare effort and have already appeared in political ads.

    Trump used Twitter on Wednesday morning to push back on the Times and Post reports.

    "The failing @nytimes writes false story after false story about me. They don't even call to verify the facts of a story. A Fake News Joke!" Trump tweeted. "Some of the Fake News Media likes to say that I am not totally engaged in healthcare. Wrong, I know the subject well & want victory for U.S."

    Trump also attacked The Post as "the guardian of Amazon not paying internet taxes" and "FAKE NEWS."

    Amazon CEO Jeff Bezos owns The Post privately, and the two entities do not have a business connection. Tax experts have debunked Trump's suggestion that The Post helps Amazon avoid taxes.

    SEE ALSO: Trump admits that Senate Republicans may not pass Obamacare repeal bill, 'and that's okay'

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    Republican Sens. Tom Cotton, John Thune, and Mitch McConnell

    Less than four in 10 voters approve of the Senate Republicans' healthcare bill, the Better Care Reconciliation Act, according to recent national polls.

    A USA Today/Suffolk University poll, conducted Saturday to Tuesday, found that just 12% of voters supported the bill, while 45% disapproved of it. And 53% of those surveyed said Congress should either leave the Affordable Care Act, the healthcare law also known as Obamacare, untouched or make changes to it while keeping its framework intact.

    A Morning Consult/Politico poll, conducted from Thursday to Saturday, found that 38% of voters approved and 45% disapproved of the Obamacare-replacement legislation. And twice as many voters — 30% — "strongly" disapproved of the bill than "strongly" approved of it.

    An NPR/PBS NewsHour/Marist poll, conducted from last Wednesday to this past Sunday, found that just 17% of voters supported the GOP bill, while 55% said they disapproved and 25% said they did not know enough about the proposal to formulate an opinion. 

    In addition, a Quinnipiac survey, conducted from last Thursday to this past Tuesday, found that 16% of Americans support the bill and 58% disapprove of it. Just 37% of Republicans said they approved of the draft legislation. Seventy-one percent of all voters, and 53% of Republicans, were opposed to cuts to federal spending on Medicaid. 

    All four polls were conducted before GOP leaders on Tuesday announced they had delayed the vote on the bill in an effort to renegotiate the bill's terms and gain more party support.

    And both the NPR and Morning Consult polls were conducted before the release of the nonpartisan Congressional Budget Office report on Monday, which projected that the bill would result in 22 million Americans losing health insurance by 2026.

    But the bill does have significant support among Republican voters.

    According to the Morning Consult poll, among registered Republicans, about 60% support the bill and a quarter oppose it, while among Democrats the numbers are reversed, with a 25% approval and 60% disapproval rating.

    About twice as many voters believe the bill would make the country's healthcare system worse, increase the number of Americans without health insurance, increase health costs for their families, and degrade the quality of care, as those who believe it would improve on these measures, according to the Morning Consult survey.

    Notably, Republican voters reflected a divide in their party between those who thought the bill did not go far enough in repealing Obamacare and those who thought it went too far. Thirty-one percent of Republican respondents said the proposed changes to the healthcare system were too dramatic, and 23% said they were not sufficiently far-reaching, Morning Consult reported.

    In Washington, GOP moderates were turned off of the bill in part because of a nearly $800 billion cut to Medicaid, while far-right senators insist on a full repeal of Obamacare.

    "The tension between moderate Republicans and hard-liners that is playing out in the Senate is mirrored in the polling," Kyle Dropp of Morning Consult told Politico.

    The USA Today poll surveyed 1,000 registered voters and has a margin of error of plus or minus 3 percentage points; the NPR poll surveyed 1,205 adults and has a margin of error of 2.8 percentage points; the Morning Consult poll surveyed 1,994 registered voters and has a margin of error of plus or minus 2 percentage points; and the Quinnipiac poll surveyed 1,212 voters nationwide with a margin of error of 3.4 percentage points. 

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    Rand Paul

    Sen. Rand Paul on Wednesday sent a letter to Majority Leader Mitch McConnell outlining requests for changes to the GOP healthcare bill.

    Taken together, they are a prime example of why the bill will be so hard to pass even as leaders try to placate divided factions of the party and amend the legislation by Friday.

    Paul announced that he would not support the current Senate bill, the Better Care Reconciliation Act (BCRA), soon after it was released because it did not go far enough in its repeal of Obamacare.

    Here's a quick rundown of the four key changes Paul is seeking in the bill:

    1. Create association health plans: This would allow groups of people to band together and create their own risk pool to access health insurance coverage. The current bill allows self-employed people to sign onto small business plans — Paul wants this expanded.
    2. Reduce spending on "insurance company bail outs": The Senate bill currently includes funding that would help insurers offset costs for low-income Americans in the individual insurance market and a state stability fund that can be used to reduce premiums and expand coverage. Paul said these merely help to grow insurance companies' profits.
    3. Eliminate premium tax credits: The current BCRA would give people making between 100% and 350% of the federal poverty line money to buy insurance. In the letter, Paul asked McConnell "to reconsider the advanced, refundable nature of this entitlement."
    4. Eliminate the continuous coverage requirement: The BCRA includes a provision that says anyone who goes without insurance for more than 63 consecutive days in a year must wait six months in the following year before they can get access to coverage again. Paul said this constituted another version of Obamacare's individual mandate and asked McConnell to "simply allow insurance companies to impose a waiting period."

    Paul's policy goals are consistent with the conservative message he has touted since the release of the House's version of healthcare reform.

    Politically, however, none of the requests are likely tenable if McConnell wants to get the needed 50 votes to pass the BCRA.

    More moderate senators, like Dean Heller of Nevada, Susan Collins of Maine, Shelley Moore Capito of West Virginia, and Rob Portman of Ohio have publicly said they would not support the current iteration of the bill because it goes too far in some of its changes to the current healthcare system. The Medicaid cuts are too deep, and the spending to help people get access to care is not enough, these senators have said.

    If McConnell meets Paul's demands, that would likely solidify those four members opposition, killing the bill.

    But attempting to pick up the moderate wing also poses a problem. Losing Paul could mean that conservative senators like Mike Lee of Utah, Ted Cruz of Texas, and Ron Johnson of Wisconsin would follow. McConnell can only afford two defections for the bill to pass.

    McConnell is reportedly aiming to get a deal done by Friday in order to get a vote on the revised bill as soon as the Senate returns from its week-long July 4 recess.

    SEE ALSO: 'Trump doesn't bring us any votes': Trump appears to be losing influence on healthcare

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    donald trump

    President Donald Trump on Wednesday suggested a "big surprise" was in store on the Senate Republican healthcare bill, a day after its progress stalled in the chamber.

    "Healthcare is working along very well. We're gonna have a big surprise," Trump said at an event in the White House with the Chicago Cubs. "We have a great healthcare package."

    When asked for clarification, Trump replied: "We're going to have a great, great surprise."

    Senate Majority Leader Mitch McConnell on Tuesday delayed a vote on the GOP bill, the Better Care Reconciliation Act, because of divisions between the conservative and moderate wings of the party.

    Moderates believe the bill goes too far in its cuts to programs like Medicaid, while conservatives say it does not go far enough in repealing the Affordable Care Act, the healthcare law better known as Obamacare.

    Trump also met with the full Senate Republican conference on Tuesday, accounts of which suggested the president seemed not to grasp some of the basics of the healthcare bill.

    McConnell is aiming to get a revised agreement on the legislation by Friday before the weeklong July 4 recess so the Congressional Budget Office can score it over the break. That would set the bill up for a vote the week of July 10.

    GOP senators on Wednesday hinted that such a deal was not close.

    Sen. Rand Paul, a conservative holdout, told reporters the conference was at an "impasse." Sen. Susan Collins, a moderate holdout, said she still saw serious, fundamental issues in the bill.

    When asked whether an agreement on the healthcare bill would be ready by Friday, Sen. John McCain told reporters: "Pigs could fly."

    Watch Trump's comments on healthcare, starting at 2:30:

    SEE ALSO: 'Trump doesn't bring us any votes': Trump appears to be losing influence on healthcare

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