Here’s what’s in the Senate GOP health care bill 2.0

Senate Majority Leader Mitch McConnell unveiled Thursday the second version of the GOP’s proposed repeal of the Affordable Care Act, but the path to passage remains anything but clear. The new bill aims to stabilize insurance costs for consumers, but also contains a controversial amendment. Julie Rovner of Kaiser Health News and Lisa Desjardins join Judy Woodruff to take a closer look.

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    It is the Senate Republican health care bill version 2.0. Party leaders made it public today, but the path to passage remained anything but clear.

    Our Lisa Desjardins begins our coverage.

  • SEN. MITCH MCCONNELL, R-Ky., Majority Leader:

    So, it's time to rise to the occasion.


    A critical moment for health care and Congress. Majority Leader Mitch McConnell unveiled Senate Republicans' second-draft bill, hoping it can win the minimum 50 votes he needs.


    The revised draft improves on the previous version in a number of ways, all while retaining the fundamental goals of providing stability and improving affordability.


    What has changed? First, it keeps two Obamacare taxes on the wealthy. Second, it uses that money, in part, to add more than over $100 billion in new spending; $70 billion would go to insurers to stabilize markets and bring down out-of-pocket costs, and $45 billion would fight the opioid epidemic.

    On Medicaid, the bill still cuts future spending significantly, but does give states more leeway to expand who is eligible for the program.

    But perhaps the biggest change is the addition of a proposal by Texas Senator Ted Cruz. The so-called Cruz amendment would let insurers mostly opt out of all Affordable Care Act requirements. They could potentially offer cheaper bare-bones plans, as long as they offer a few plans that do meet Obamacare standards.

    At the same time, other Republicans are crafting their own ideas.


    Well, you know. We're going to support Mitch's effort with his new plan, but we want an alternative, and we're going to see which one can get 50 votes. We're not undercutting Mitch. He's not undercutting us.


    Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana say their amendment would send more money directly to states. It's not clear how much support that has.

  • As for Democrats:

  • SEN. CHUCK SCHUMER, D-N.Y.., Minority Leader:

    It appears that little has changed at the core of the bill.


    Minority Leader Chuck Schumer says Republicans will still have a problem getting some key members of their own party on board.


    Moderate Republicans looking at this bill should be able to see that the incredibly modest change to the tax provisions, the small pot of funding for opioid abuse treatment, these other tweaks around the edges are like a drop in the bucket, compared to what the bill does to Medicaid, to seniors, to Americans with preexisting conditions.


    All sides are now waiting for a pivotal report, the analysis of the bill by the nonpartisan Congressional Budget Office.

    Especially waiting is Wisconsin Senator Ron Johnson, a key vote.


    Show me your math. Show me what the first baseline was. Show me what the policy results in terms of spending.


    Republicans have not yet announced when they will hold a vote. Leaders had hoped for next week.

    And of the 52 Senate Republicans, we already know that two of them are no-votes on this latest draft. That's Susan Collins of Maine and Rand Paul of Kentucky.

    Judy, of course, that means Mitch McConnell cannot lose any more Republicans, and there are many on the fence.



    So, Lisa, thank you. And, of course, stay here.

    We're going to bring in Julie Rovner, who we know well, chief correspondent, Washington correspondent, for Kaiser Health News, joining us too.

    I'm going to start with you, Julie.

    So, there have been some changes, as Lisa just reported, to Medicaid, a few, but not enough to satisfy these moderates. What exactly did they do?

  • JULIE ROVNER, Kaiser Health News:

    That's right.

    The moderates have been unhappy with the Medicaid cuts. Senator Susan Collins, who, as we just heard, is already a no, came out and said, the changes that they would make to Medicaid go beyond repealing the Affordable Care Act. Medicaid was expanded in the Affordable Care Act, but these changes would actually cap the program, something Republicans have been trying to do since the 1980s.

    It's for the conservatives. Moderates are still unhappy. As Lisa pointed out, there is a little bit more money to deal with opioid abuse. They can get out of the caps if there's a public health emergency. But those are pretty much all the changes that they have made here.


    And how is all this going over, Lisa?



    There are a lot of big question marks on Capitol Hill. I think that you have got the same question marks on the right and the left. They tried to bring in moderates, and including giving them the ability to increase — the states could increase who can be under Medicaid.

    But there's not as much money to do it, so you would have to make a choice between the number of people you could cover under Medicaid and how much you would give them in benefits. It doesn't really address questions of the overall need for health care some of these moderates have.


    Now, Julie, we heard in Lisa's report the reference to what Senator Ted Cruz has wanted, has to do with giving states more options.

    Describe exactly what that involves.


    Well, Senator Cruz and a number of the conservatives in the House too have complained that one of the biggest problems with the Affordable Care Act is that people who buy their own insurance are finding themselves paying much more, more both in premiums and in out-of-pocket spending.

    And he wants to help people. But basically the way he would do it is, he would say, for healthy people, if you want to buy fewer benefits, you can do that, and you would get less coverage. And that, in fact, is what they would do in this bill.

    The problem, according to the insurance industry and a lot of others who oppose it, is that it would make coverage for sick people pretty much unaffordable. It would leave only sick people in those plans that offer all the benefits.

    For the people who are lucky enough to get tax credits, and they have lowered the threshold, those people would be mostly protected from those increases. But people who are buying their own insurance and make too much money to get those tax credits would bear the brunt of those very much higher premiums. So that's a big worry about how this might play out.


    So, Lisa, and the leadership was making this gesture in Senator Cruz's direction. How is it going over?


    These were intense negotiations to put this in the bill today.

    But, Judy, if you actually read the bill online, the entire Cruz amendment is in brackets. Literally, it is in brackets. And Republican leadership confirmed that means it's not final. It could still be taken out. It could still be revised.

    And one other tricky piece of choreography with all of this, multiple sources have told me that they are going to get a score from not CBO — just from CBO, but also the Department of Health and Human Services. which is a very unusual step on this.

    They are going to see what the Department of Health and Human Services think the Cruz amendment will mean. And all of this is kind of adding new questions to the process as well.


    Presumably not knowing what the department is going to say. Is that right? Or do they assume the department is going to come in and say this is a good thing?


    That, we don't know.

    We know there have been conversations for weeks with CBO. CBO has known the general outlines of these bills. Have they had those conversations with HHS as well? I don't know.


    Lisa, I want to stay with you.

    You have been following this day after day after day since the Senate went home for recess. They have now come back. What is the political calculus on the part of the Republican leadership in the Senate?


    I think it comes down to one fact, that they feel they campaigned on this and that they have to at least give it their greatest try or have to show themselves as trying as hard as possible.

    Right now, it does look like it's going to be very difficult to get the votes for this to pass, but it also looks like they will hold that vote, even if it fails, to show their voters, we tried and this is as far as we could get.

    I think there is pressure from both conservatives an moderates to go both different directions. And that's what making this goal of reforming and replacing Obamacare impossible.


    Julie — excuse me.

    Julie, you have done your own share of reporting on this for a long time. What are you seeing as to where this goes?


    I see exactly what Lisa said, that they're caught between this promise that they made to repeal and replace the Affordable Care Act and their ability to do it, which is difficult to find consensus within their own conference.

    So, I think they're going to sort of run out the string as much as they can. The bigger problem is, even if they get something through the Senate, then it will have to go back to the House. So whether you could actually get something through both chambers in any kind of timely way remains a big open question.


    And then we heard, Lisa, the president saying that he would be angry if the Senate doesn't get this done.



    And to be honest, sources I talk to, Republicans, aren't sure the president has helped-, because as much as he's behind the scenes sometimes encouraged them, when he's gone and criticized the House bill later on, for example, as being mean, they're worried that if they join forces with him, that later he might say something different.

    I think, overall, it's important to just remember the broad contours of this bill. There are a lot of details, a lot of changes. But as much as it deals with the Affordable Care Act, this bill in its heart is also a Medicaid reform bill.

    That was something they didn't have to add to this, but they did. And in doing that, they lost a lot of moderate votes. They're keeping with that because Republicans feel like it's important, but that was a big gamble that they took in actually putting two bills together here.


    All right, my producer is trying to tell me something about senators. Maybe there is new some information?



    … watch, particularly.


    I think that's right.

    We need to watch a lot of key senators this week. Let's look at five very quickly. That's Ron Johnson of Wisconsin. We talked to him today. Mike Lee of Utah, he's not happy with the Cruz amendment as written, even though was one of its authors at the beginning.

    Shelley Moore Capito of West Virginia. Dean Heller of Nevada, he's interesting. His governor today said he has great concerns about the bill as it is. And, of course, Lisa Murkowski of Alaska, she had said she didn't like where this is going. And we're waiting to hear from all five of those.

    They can't lose any one of those. And that's just the beginning lineup of questions.


    I know the two of you are going to keep monitoring it every minute of every day until we know what the answer is.

    Lisa Desjardins, Julie Rovner, thank you both.


    Thank you.

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