WASHINGTON — Senator Susan Collins of Maine, a pivotal Republican moderate, joined a small but potentially decisive GOP rebellion Monday and said she will not support her party’s health care bill after government specialists estimated that the legislation would cause 22 million Americans to lose insurance.
That 10-year projection from the nonpartisan Congressional Budget Office threw the outcome of a planned Senate vote on the bill this week further into doubt.
“It’s obviously not positive,’’ Collins told reporters soon after the CBO released its report.
She later tweeted that she would not support a motion to proceed to a full vote on the measure, although she signalled further changes could bring her on board.
“I want to work w/ my GOP & Dem colleagues to fix the flaws in (the Affordable Care Act.) CBO analysis shows Senate bill won’t do it,’’ she wrote. “CBO says 22 million people lose insurance; Medicaid cuts hurt most vulnerable Americans; access to healthcare in rural areas threatened.’’
Majority leader Mitch McConnell is pushing for a vote before the Senate’s Fourth of July recess and can only afford to lose two Republican votes. But the CBO score made that target a much steeper, if not impossible, climb as Collins’s opposition piled on to that of other conservative and moderate Republicans and threatened to derail the bill.
Even before the estimate released Monday, Collins and several other moderate Republicans were on the fence.
The Congressional Budget Office assessment highlighted why Republicans are struggling so much to make good on their seven-year-old political promise to repeal former president Barack Obama’s Affordable Care Act.
President Trump promised a replacement that would appeal to his working-class, white base in rural areas. But in their bill, Senate Republicans want to slash Medicaid programs by $722 billion while cutting taxes on the wealthy and corporations by about $540 billion. Loss of insurance coverage would fall disproportionately on low-income people between 55 and 64, the CBO said, a key demographic in Trump’s base.
The 22 million who would lose insurance under the Senate plan is only slightly less than the 23 million estimated to lose it under the House plan, which Trump has called “mean.’’
The estimate said the bill would shrink the federal deficit by $321 billion over 10 years, a bright spot for Republicans that also gives McConnell some room to add spending provisions to win over colleagues.
That means the moderates are getting plenty of attention.
Until Monday, Collins was among a group of noncommittal moderates that included Bill Cassidy of Louisiana, Lisa Murkowski of Alaska, Rob Portman of Ohio, Jeff Flake of Arizona, and Shelley Moore Capito of West Virginia.
“Our phones are blowing up on this,” Cassidy said. The CBO report made him “more concerned” about voting for the bill than he was before, he said.
“Coming in I was dead-set undecided,” Cassidy said. “I remain undecided.”
The Senate GOP bill would repeal the so-called individual mandate that requires people to buy insurance or pay a penalty. Instead, under a last-minute change, the bill would seek to encourage healthy people to buy coverage by imposing a six-month waiting period on those who go more than 63 days without coverage.
In addition to big cuts in Medicaid, the bill would give many lower-income Americans smaller subsidies to buy less generous, higher-deductible plans from the Affordable Care Act exchanges, which provide individual insurance.
While Republicans have trumpeted the legislation as fulfilling their years-long promises to repeal Obamacare, it’s clear they are using their base’s anger to push through another conservative priority: slashing entitlement spending.
The Senate and House bills would also for the first time impose permanent caps on federal Medicaid spending, ending what is now an open-ended guarantee that the federal government will match what states spend, no matter how high an enrollee’s bills climb.
Many experts and providers say the Senate system will lead states to cut back on benefits provided to enrollees and slash the number of people eligible for the program. The bipartisan group that represents state Medicaid directors called the Senate bill changes “a transfer of risk, responsibility, and cost to the states of historic proportions” and criticized the proposed rate of growth of federal spending as “insufficient and unworkable.”
Republican leaders are dealing with the disconnect between their goal of a massive Medicaid overhaul and Trump’s populist promises by pretending there is no disconnect.
“What our goal is, is to make it so folks on Medicaid . . . [have a] program that works for them in a way that allows them to get the kind of care and the coverage that they need,” said Health and Human Services Secretary Tom Price, when asked on CNN Sunday about concerns raised by Brian Sandoval, the Republican governor of Nevada, and the state’s GOP senator, Dean Heller, considered a key swing vote for the bill, that the bill’s deep cuts to Medicaid funding would cause hundreds of thousands of Nevadans to lose health coverage.
“Nobody will fall through the cracks,” Price reiterated on Fox News Sunday.
“These are not cuts to Medicaid,” said White House adviser Kellyanne Conway, on ABC, pointing out that federal Medicaid spending would continue to rise each year — which is technically true, but growth would be dramatically curtailed from current projections.
Heller said at a Friday press conference announcing his opposition to the current bill that it was inaccurate to say the bill would lower premiums.
“I’m telling you right now, I cannot support a piece of legislation that takes insurance away from tens of millions of Americans and hundreds of thousands of Nevadans,” Heller said.
Others were more direct in their criticism of the GOP descriptions.
“It’s a degree of lying I’ve never seen in politics before,” said Craig Garthwaite, a Republican health economist at Northwestern University’s Kellogg School of Management. “It’s not starting from some truth and then nuancing it to get a better message. It’s fundamentally saying up is down. ‘We are not cutting Medicaid.’ Yes you are. And we can have a debate about how we want to fund health insurance for low-income people . . . but you should have a debate about that, and weigh the relative merits of that.”