As GOP health care plan collapses, Daines again supports repealing Obamacare without replacement

HELENA - Montana's Republican Sen. Steve Daines said Tuesday he would vote for a repeal of the health care law without a replacement, but later in the day even that plan appeared to be doomed.

"I would support a repeal," Daines said Tuesday morning. "We have a health care system in this country that is collapsing on the individual market and we have a health care system that is producing financial outcomes at the state government level that are not sustainable."

Daines voted for repeal before in a 2015 effort that was vetoed by former President Barack Obama.

But later Tuesday, three Republican senators, Susan Collins of Maine, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia said they could not support a repeal without a replacement. Senate Majority Leader Mitch McConnell, R-Kentucky, told reporters later in the day he would still hold the repeal vote though it does not have enough support to pass. In 2015 the repeal attempt passed the Senate 52-47 but was was vetoed by former president Barack Obama.

"I didn't come to Washington to hurt people," Capito said.

The Senate must go to a 51 vote majority instead of current 60 votes. Even parts of full Repeal need 60. 8 Dems control Senate. Crazy!

- Donald J. Trump (@realDonaldTrump) July 18, 2017

Daines was one of seven Republican senators who had dinner with Republican President Donald Trump on Monday evening. The other senators include John Thune, of South Dakota; Lamar Alexander, of Tennessee; Roy Blunt, of Missouri; Richard Shelby, of Alabama; James Lankford, of Oklahoma; and John Cornyn of Texas.

"Health care was certainly part of that discussion," Daines said. "We talked about the need to get the economy growing again and tax reform. We talked about the concerns of the $20 trillion dollars of debt and the fiscal challenges we face as a nation and we also spent some time looking at how do we get Congress to act more quickly and efficiently."

After Daines and the other senators left the dinner, news broke that Republican Sens. Mike Lee of Utah and Jerry Moran of Kansas would not support the Better Care Reconciliation Act and would not vote for a motion to bring the bill to the floor. It was Senate Republicans' most recent iteration of a bill to repeal and replace the Affordable Care Act. Then, McConnell floated the repeal without replacement option.

On Tuesday morning, Daines said that while he supports a repeal, he wants to see Congress continue to focus on a replacement plan because of the possibility Montana ends its Medicaid expansion program in 2019, which could leave nearly 80,000 without insurance.

When the Montana Legislature passed the Health and Economic Livelihood Partnership in 2015, it included a sunset of 2019 to give lawmakers the option to assess how the law is working and vote to renew it. Aside from the state-imposed sunset, the Better Care Reconciliation Act gave states less money for expansion than under the Affordable Care Act, which would have also ended expansion.

Daines cited a story by the Associated Press than ran in papers around the state Tuesday quoting the state senator who carried the expansion bill voicing concern about its continuation.

"They promised that they would make it work," Sen. Ed Buttrey, R-Great Falls, told the Associated Press. "And if they don't, then the program needs to change, or there will be a great risk that it could go away."

Daines said that means Congress needs to act soon on a new health care bill.

"We don't have two years to wait to take action in terms of a replacement plan. We've got to provide a place for those who are on Medicaid expansion to land so they have health care coverage, they have options, they have choices if this Obamacare collapses. ... It's important we have a federal law that provides a place for these Montanans to land so they can still have access to affordable health care."

Daines said the "collapse" of exchanges that sell insurance will continue until there's a replacement.

"If we look at what's happening in Montana, which is similar to what we're seeing around the country with 133 percent increase in premiums, the poverty tax, that is the mandate where the IRS assesses a tax penalty on those who have not bought health care in Montana," he said.

In 2016, the three insurers that sell plans on the exchange in Montana proposed rate increases of from 20 percent to 62 percent on average. Blue Cross and Blue Shield of Montana pitched increases from 40 to 108 percent, depending in the plan. About 85 percent of Montanans get a premium tax credit that offsets rate increases.

At the time, Blue Cross said the increase was needed because claims and health care costs have been higher than expected. The company collected $174.7 million in premiums for individual plans and paid out $220.6 million in claims in 2015 for a loss ratio of 126.3 percent, according to a rate change request summary.

This year Blue Cross proposed an average of 23.1 percent rate increase, while the Montana Health Co-Op proposed a 4 percent increase and PacificSource proposed for a 7.4 percent increase.

At the start of July during a health care forum in Helena, the CEO of one of Montana's largest hospitals said Republicans are are injecting instability into federal insurance marketplaces by suggesting lowering subsidies for people who buy coverage, calling the move a “slick trick” to ensure the failure of the exchanges.

“All you have to do is threaten to defund the subsidies,” Benefis CEO John Goodnow said. at a panel in Helena organized by the Montana Nurses Association to discuss the bill.

During a town hall conducted by phone last month, Daines told callers that in 2014 more than 30,000 Montanans were penalized by the IRS for not having health care. Daines said Montanans paid more than $7.8 million.

"Here's the shocking part of that data: 40 percent of those Montanans make incomes of less than $25,000 a year. This is a poverty tax put into place by Obamacare that needs to be replaced."

Critics of the data on fines, which was shared by several Republican senators in the past weeks, say that Medicaid expansion would have provided coverage to some of those who were fined and more updated data would show a decrease in fines.

The Montana Nurses Association criticized Daines' support of a repeal without a replacement and released the following statement Tuesday:

"Sen. Steve Daines made a conscious decision to leave Montana citizens behind. ... Proposing to repeal the law in any form without having an alternative health care plan to replace would destabilize our health care system and jeopardize lives across our state."

During the dinner with Trump, Daines said he and the six other senators had an hour-and-a-half discussion "across a wide range of topics."

The senator said he brought up the filibusterer rule in the Senate, something the president tweeted about Tuesday morning, saying: "The Senate must go to a 51 vote majority instead of current 60 votes. Even parts of full Repeal need 60. 8 Dems control Senate. Crazy!"

The Senate must go to a 51 vote majority instead of current 60 votes. Even parts of full Repeal need 60. 8 Dems control Senate. Crazy!

- Donald J. Trump (@realDonaldTrump) July 18, 2017

On Tuesday morning, Daines called the Senate rules "archaic."

"These are archaic rules from the past that are creating, are going to create barriers for the Senate to act on behalf of the American people. It is time tho blow up the filibuster. ... I was pleased to see the president tweet that out."

Daines also said Trump focused on increasing the pace at which Congress works.

"I think one of my other takeaways from dinner last night was President Trump wants to move at the speed of business, not at the speed of government. He wants to see results. ... Congress has to have the ability to walk and chew gum. We can do more than work on just one thing. We need to work on tax reform, we need to work on infrastructure, we need to work on sanctions against North Korea. There are a number of threats facing our nation, and we need to work on more than one thing."