Michigan Democrats attack Senate Republican health care proposal

June 22--WASHINGTON -- As Republican leaders in the U.S. Senate today revealed a draft of health care legislation they say will stabilize individual insurance markets, Democrats from Michigan and elsewhere attacked it as mean-spirited and stingy, saying it will hurt lower-income families and seniors.

"Frankly, we'd like to have a ceremony and light this on fire," U.S. Sen. Debbie Stabenow, D-Mich., said on the Senate floor, waving a copy of the 142-page draft legislation as she argued against the bill, which is intended to repeal and replace the 7-year-old Affordable Care Act, otherwise known as Obamacare.

Senate Majority Leader Mitch McConnell unveiled the draft bill, which follows a U.S. House vote on a similar measure in May that could have far-ranging impact in Michigan, where 1 million people get coverage on ACA exchanges or through Healthy Michigan, the state's Medicaid expansion plan.

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The legislation eliminates the requirement that people have insurance, reins in Medicaid spending and eligibility, and cuts back insurance premium subsidies for some low- and middle-income Americans. A vote on it could come next week before the Senate takes its July 4th recess.

Other portions of the bill:

* Eliminate requirements that insurers on the exchanges provide essential health benefits such as prescription drug and maternity care as of 2020.

* Allow states to put in place work requirements for Medicaid coverage for the poor and experiment with ways to contain costs while providing care.

* Keeps in place requirements to cover pre-existing conditions and let children stay on parents' policies until age 26, though if subsidies decreas,e those policies could cost people more.

Saying the ACA currently "teeters on the edge of total collapse," McConnell, R-Ky., opened the Senate session today talking about the bill, which was drafted in secret by a group of about a dozen Republican senators and the subject of no hearings, saying that without action now, "more Americans are going to be hurt" by higher prices and insurers pulling out of areas.

"American families deserve better than its failing status quo," he said.

McConnell and other supporters of the bill will first need to get enough Republican support, however. If Democrats and the Senate's two independents vote against it, the majority Republicans can lose no more than two votes. But already some conservative GOP senators indicated they were not ready to support it and some more moderate Republicans were expected to balk as well.

One of the latter, U.S. Sen. Dean Heller, R-Nev., said, "I will read it ... As I have consistently stated, if the bill is good for Nevada, I'll vote for it and if it's not -- I won't." Sen. Rob Portman, R-Ohio, voiced similar sentiments, saying while there are "are some promising changes to reduce premiums in the individual insurance market ... I continue to have real concerns about the Medicaid policies in this bill."

Many Republicans were largely silent. There were also no immediate statements of support from the Republican Party nationally or in Michigan or from GOP members of the state's congressional delegation.

That may not be surprising, however, given the scope of the bill, the secrecy around it and the lack of time people had to digest it.

President Donald Trump tweeted later in the day: "I am very supportive of the Senate #HealthcareBill. Look forward to making it really special! Remember, ObamaCare is dead."

U.S. Sen. Gary Peters, D-Mich., said the Senate legislation does little to address the concerns being felt in the state.

"While I'm still reviewing the details of the bill, it appears similar to the House Republicans' bill that strips millions of hardworking families of their health care coverage, increases costs for seniors and makes health care coverage for people with preexisting conditions largely unaffordable," he said.

"We need to fix those things that are not working (about Obamacare)," said Stabenow, claiming the Republican bill is "worse for seniors, for those in nursing homes, for children in Michigan" and others.

That's not to say the proposal doesn't have supporters: While Michigan Democratic Party Chairman Brandon Dillon excoriated the proposal, saying it's "meaner, cuts deeper, and will hurt even more Americans" than the House version, U.S. Chamber of Commerce President and CEO Thomas J. Donohue said it has the chance to "stabilize crumbling insurance markets ... curb runaway premium increases and jettison ill-conceived Washington mandates and taxes."

"We know that Obamacare is dangerously close to collapse as millions of Americans are left with fewer and fewer options for health insurance and urge senators to move forward and ultimately pass this legislation without delay," Donohue said.

Asked whether Gov. Rick Snyder, who is traveling in Europe, had any reaction, communications director Ari Adler said his office needs "time to review the potential impact on Michigan's insurance markets, Medicaid program and the Healthy Michigan Plan."

Leading up to the House vote this spring, Snyder had urged legislators to reconsider the bill, pushing for continued support for programs such as Michigan's Medicaid expansion program, which was authorized and paid for under ACA.

Healthy Michigan serves some 670,000 people in the state whose families earn just over the federal poverty limit. Snyder has repeatedly pointed to evidence that it is reducing costs in other areas, such as emergency room visits, by using a formula that lowers recipients' costs for adopting healthy behaviors.

Like the House bill, the proposed Senate bill moves to roll back Medicaid expansion and reduce overall Medicaid costs by adopting a per-capita amount for states that would then increase with the consumer price index, despite evidence that may not keep up with total costs.

As of April, there were approximately 1.8 million Michiganders receiving Medicaid coverage, which covers low-income families and individuals. Like the House bill, the Senate bill would allow states the flexibility to replace per-capita amounts with block grants to test if they are more cost effective.

While there were similarities between the House and Senate bills, there were also significant differences, notably regarding premium subsidies for people making up to four times the federal poverty limit, which is currently $12,060 for an individual and $24,600 for a family of four.

Under the House bill, those subsidies were tied to the age of the recipient in such a way that -- when taken with other changes -- were expected to lead to much higher costs in some cases for seniors. The Senate bill does not tie it to age but cuts off subsidies at 3 1/2 times the poverty limit instead of 4.

It also scales back those subsidies in other ways, however, linking their amount to plans that would be less generous -- and, therefore, cost less -- and increasing the percentage of income people would be expected to spend on their own insurance, especially older Americans slightly higher on the income scale, before the subsidies would cover the difference.

Those changes could impact the more than 321,000 Michiganders who buy insurance on the ACA exchanges, the vast majority of whom -- about 260,000 -- who receive some kind of premium subsidy. While the average monthly premium of the plans they have is about $400, after their subsidies, which is calculated as a tax credit, they pay on average of about $188 a month.

Republicans, however, have long railed against what they see as the potential for runaway costs and regulations that not only force insurers to draw up expensive plans but strip other choices away from other people on the individual markets.

Democrats have countered that the greater good is for all Americans to have some kind of insurance, with younger, healthier individuals getting coverage and their premiums, at the same time, balancing the risk pool to help pay for older, less well-off Americans with greater health care needs.

The legislation would also make numerous other changes to the current law, defunding Planned Parenthood for one year, repealing certain cost-sharing subsidies and eliminating taxes on medical devices and prescription drugs. It would also after 2020 allow insurers to issue policies not covering certain "essential health benefits" including emergency services, maternity and newborn care, prescription drugs, preventative care, hospitalization and other services.

The bill includes $50 billion over the next four years to help stabilize insurance markets, however, and "help balance premium costs," presumably for those facing monthly bills that might suddenly skyrocket. Another $62 billion over eight years would be used to help states "assist high-cost and low-income individuals" get health insurance, by potentially providing assistance with monthly premiums, offsetting costs to insurers and developing programs to help pay for out-of-pocket expenses for people with high insurance bills.

While mandates on individuals to have insurance -- and small employers to provide it -- would be lifted, children could still remain on parents' policies until age 26. It also appeared that the proposal -- which Republican leaders say is open to amendment -- maintains a ban on refusing insurance to people with preexisting conditions.

While premium increases in Michigan haven't been as bad as in some parts of the country, they've been getting worse: Last week, the Free Press reported that some health insurers in the state were seeking record-level rate hikes as high as 31% for next year.

In the case of Blue Cross Blue Shield of Michigan, the state's largest insurer said its proposed 26.9% hike on the individual market is being driven in large part by far-higher prescription drug prices but also by people dropping coverage shortly after having procedures done and younger, healthier individuals staying out of the market despite the mandate that they have insurance.

If and when the Senate votes, any legislation it passes will still have to pass back to the House, to be approved once again before a final version is sent to the president for his signature. But with conservative and moderate Republicans battling over what should be in the bill, it could be difficult to reach a final consensus.

Contact Todd Spangler at [email protected]. Follow him on Twitter at @tsspangler.

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