House OKs GOP bill erasing much of Obama’s health care law, answering campaign pledge and sending measure to Senate. (May 4) AP
WASHINGTON – When Sen. Rob Portman emerged from a closed-door Republican meeting on health care earlier this week, he was swarmed by reporters peppering him with questions about the private strategy session.
The scene showcased Portman’s sudden prominence as the Senate crafts its version of legislation to repeal and replace Obamacare. The Ohio Republican is one of about a dozen GOP senators tapped to draft a health care plan that can win enough votes to squeeze through the Senate, where Republicans hold a narrow 52-seat majority.
Portman is hoping to be a moderating force in the debate, working to soften the Obamacare replacement bill that Republicans passed in the House last week. But his efforts will run smack up against the Senate’s hard-charging conservatives, who are trying to move the bill in the opposite direction.
“Given the House process, it’s hard to see how the perfect bill emerges,” said Dan Holler, a spokesman for Heritage Action, a conservative advocacy group.
In the House, conservatives torpedoed an early version of the bill, and then came around after GOP leaders made concessions to win them over — but those concessions drove away some moderate Republicans.
In the Senate, nowhere will the GOP tug-of-war be more intense than over the Affordable Care Act’s Medicaid expansion provision, which allows states to enroll low-income childless adults in that joint state-federal program and have Washington pick up most of the tab.
In Ohio, Medicaid expansion has helped about 700,000 people gain health coverage, with many accessing desperately needed services for addiction treatment as the state grapples with the opioid epidemic. Ohio Gov. John Kasich has championed the Medicaid expansion as a transformative success for Ohio’s most vulnerable residents.
The House-passed bill would freeze the Medicaid expansion program in 2020, with states losing the extra federal money to cover new enrollees. The possible result in Ohio: either a huge hole in state’s budget or a big spike in the uninsured rate, which has dropped in half since the ACA’s enactment.
Kasich has blasted the House bill as “woefully short” in assistance for low-income Americans. And Portman has echoed that, saying the House bill would drop states off a funding “cliff” and could jeopardize Ohioans’ access to opioid-addiction treatment.
The senator is pushing behind the scenes for a more gradual phase-out, so the spigot of federal money would be turned off slowly, instead of being snapped shut on Jan. 1, 2020.
“That seems too steep to me, so I have specifically called for a smoother glide path, meaning a transition, so that Ohio can get ready for it,” Portman said in an interview Wednesday.
He would not say specifically how long of a transition he was pushing for. But any effort to extend or preserve the ACA’s Medicaid expansion is likely to be met with fierce resistance by conservatives, who are clamoring for deeper cuts to a program they say is busting the federal budget.
“We need Medicaid reform that … constrains that exploding cost curve that we see going forward and that also gives states considerably more flexibility,” Texas Sen. Ted Cruz said earlier this week. Cruz, a firebrand who faced off with Kasich in the 2016 Republican presidential primary campaign, is also part of the Senate GOP working group.
Cruz, who pushed Republicans to take a hard line during the 2013 government shutdown over defunding Obamacare, declined to say whether he was open to Portman’s proposal for a more gradual phase-out.
Asked about the House bill’s provision to keep Medicaid expansion in place until 2020, Cruz said only that he and others had “raised concerns” about that, declining to elaborate as he hopped in an elevator with his aides.
One thing both Portman and Cruz agree on: It will be a “struggle,” as Portman put it, to forge consensus on Medicaid. And that’s hardly the only flashpoint in the GOP’s closed-door tussle over health care, with other battles already bubbling up over defunding Planned Parenthood and protecting patients with pre-existing conditions.
Holler said centrists such as Portman will need to make concessions on other issues if they expect to gain ground on Medicaid expansion. How lawmakers balance the competing interests will go a long way to determining if they can craft a bill that wins at least 50 votes, he said.
One Democrat, Sen. Edward Markey of Massachusetts, joked that Republicans were chasing a “unicorn” in their search for consensus on a plan to repeal and replace the ACA. Democrats are expected to oppose the bill in full force, so Republicans can lose only two senators from their own ranks for it to pass — and that’s with Vice President Pence serving as a tie-breaker.
“That is not an easy task,” Cruz said, “but I believe it’s a task we can accomplish.”
Whatever proposal Senate Republicans come up with, it’s sure to become a political football ahead of the 2018 midterm elections. Some Republicans have faced angry constituents pushing for Congress to fix the ACA instead of repealing it. And while Portman just won a second term in the Senate, he has not escaped the public pressure, with protesters and liberal activists showing up at his district offices in Cincinnati to register their discontent.
“We’re keeping tabs on his efforts and what he’s proposing,” said Morgan Showen, an organizer for Cincinnati Indivisible, a liberal youth-led advocacy group.
How to weigh in:
Sen. Rob Portman, R-Ohio
448 Russell Senate Office Building
Washington, DC 20510
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