Hoeven not ready to weigh in on Senate health bill

June 23--WASHINGTON -- Sen. John Hoeven, R-N.D., is reserving judgement on a draft of a new health care bill unveiled Thursday that would largely replace the Affordable Care Act and restructure Medicaid, telling the Herald he wants to review the legislation and see a report from the Congressional Budget Office.

The "discussion draft" of the Better Care Reconciliation Act, an outline of the Senate's version of the American Health Care Act that passed the House of Representatives last month, shows a plan to phase out Medicaid expansion from the ACA in 2021 among other changes.

The bill was crafted by Republican leadership without public hearings, a process Hoeven has criticized.

He told the Herald he attended an hour-plus briefing going over the draft Thursday morning to review the highlights and that his staff is going through the bill, but he hasn't read the 142-page document yet.

"We're going to go through and make sure we understand it," Hoeven said. "I'm also going to reserve judgement obviously until we get a CBO score."

Sen. Heidi Heitkamp, D-N.D., spoke out in opposition to the draft Thursday, saying it was a slightly better version of the House-passed ACHA but still will make health care unaffordable for North Dakotans and Americans in general.

"This isn't who we are as a country," Heitkamp said in a statement. "And it isn't who I am as a North Dakotan."

A Center for American Progress analysis estimated the House ACHA would eliminate health coverage for 30,100 North Dakotans.

North Dakota Republican Rep. Kevin Cramer voted for the ACHA.

The CBO report on the ACHA estimated it would cut Medicaid funding by about $800 million over a decade.

Minnesota's DFL Sens. Amy Klobuchar and Al Franken both spoke against the Senate draft Thursday.

Hoeven said Democrats' attacks on Medicaid reductions do not take into account the Republican draft proposal to expand the pool of those eligible for tax credits to pay off high premiums.

"It's just not covering low-income people with Medicaid, it's coordinating between Medicaid and the refundable tax credit," Hoeven said.

The ACHA based refundable tax credits on age, but the Senate version would base tax credits on age and income. Hoeven said he believes low-income people will have their high premiums offset by tax credits, while high-income people will experience more robust competition in a more open market that will lower premiums.

"The idea is you want more competition," Hoeven said.

Hoeven said he is concerned about reductions in funding to Medicaid, but said the way Medicaid is funded should be reversed to pre-ACA conditions. Under the ACA, the federal government provided states that expanded Medicaid with at least 90 percent of their costs

Hoeven said this model is unsustainable and needs to be changed to a per capita limit based on how much federal funding had previously gone into each state's Medicaid system.

"I want to make sure, and I'm still working on it, as we move to the per capita cap approach, that it works for the states and health care providers so that folks do have access to Medicaid," Hoeven told the Herald.

Hoeven said he hopes work going forward on Senate bill will be done through open committees.

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