Senate Republicans, driven by their push to repeal Obamacare, turned the spotlight on Democrats Thursday by forcing them to stake out a position on a controversial alternative to the GOP’s free-market push — government-run, single-payer health care.
Sen. Angus King, Maine independent, and four red-state Democrats facing re-election next year voted against the plan offered by Sen. Steve Daines, Montana Republican.
But Sen. Bernard Sanders, Vermont independent who openly backs single-payer, joined 42 Democrats and voted “present” as a way to avoid taking the bait from Mr. Daines, who rejected his own plan during the 57-0 roll call.
Mr. Sanders said if Mr. Daines “is serious about a Medicare for all proposal, let us work together, but now is not the time for political games.”
Republican leaders have used single-payer as a way to spur their GOP troops during the debate over repealing Obamacare, saying the alternative to failure would be a renewed push for government-run health care.
Majority Leader Mitch McConnell said the European-style plan would “quadruple down” on the Affordable Care Act’s problems and could cost taxpayers up to $32 trillion, citing one leading analysis.
Republicans also say single-payer could lead to wait lists and rationing of care and is a political loser for Democrats, particularly vulnerable ones facing election next year in states that President Trump won.
Four Senate Democrats who fit that description — Joe Donnelly of Indiana, Heidi Heitkamp of North Dakota, Joe Manchin II of West Virginia and Jon Tester of Montana — voted against the plan Thursday.
Moderate Democrats are focused on repairing Obamacare or seeking bipartisan fixes to it, though vocal progressives are squeezing them from the left.
Some of the protesters who’ve rallied to the Democrats’ side outside of the Capitol this week are demanding single-payer, and progressive stalwarts such as Mr. Sanders and Sen. Elizabeth Warren of Massachusetts say Democrats should focus on the reform once the battle over Obamacare repeal is over.
Champions of single-payer say its detractors overstate its costs, because it would overhaul how the U.S. pays for health coverage instead of tacking more costs on top of what’s being spent now.
Later Thursday, the Senate is slated to kick off a “vote-a-rama” on amendments that will largely serve as political messaging vehicles. The marathon session could last deep into the night and is tied to the budget process that Republicans who hold a 52-seat majority are using to avoid a Democratic filibuster of their Obamacare repeal plans.
Democrats say they don’t want to offer any amendments until they find out what bill Mr. McConnell will lay before the chamber at the end of the process.
Republican leaders are floating a “skinny” repeal that can gather consensus from the fractious GOP conference.
Details are still being finalized, but aides said at last notice, it would ditch Obamacare’s unpopular mandate requiring individuals to hold insurance; scrap its rule requiring large employers to provide coverage for at least six years; give states greater flexibility to pursue their own insurance rules; repeal Obamacare’s public health and prevention fund; and shift funding from Planned Parenthood to community health centers.
It would no longer repeal Obamacare’s tax on medical device sales.
The idea is to pass a “lowest common denominator” repeal bill so that Senate negotiators can sit down with House lawmakers, who passed a replacement plan in May, and try to work out a broader deal in a conference committee.
“My sense is people aren’t so much focused on the substance as this being the lifeline to get to conference,” Sen. Bob Corker, Tennessee Republican, said after a party lunch.
Yet the gambit relies on House assurances they will go to conference on the bill, rather than taking it up and passing it, forcing senators to consider whether they should vote for policies they wouldn’t want to become law.
The main insurers’ lobby said a limited repeal bill would disrupt the markets ahead of mid-August deadlines to set 2018 rates.
“This continued uncertainty — combined with targeted proposals that would eliminate key elements of current law without new stabilizing solutions — will not solve the problems in the individual market, and in fact will result in higher premiums, fewer choices for consumers, and fewer people coverage next year,” Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, said in a letter to Senate leaders.
AHIP particularly objected to repealing the individual mandate without an alternative way to prod healthy people to sign up and begin paying premiums, before they get sick and submit costly medical claims.
The Congressional Budget Office estimated that 16 million fewer people would hold insurance by 2026 under a plan that removes the mandate, according to an analysis requested by Senate Democrats.
The individual mandate didn’t prod a sufficient number of healthy people into Obamacare’s exchanges in the early rounds of enrollment, however, leading to dramatic premium increases.
Democrats want to patch up the law in bipartisan talks instead of starting over.
“We know Obamacare needs some work. We don’t deny that,” Senate Minority Leader Charles E. Schumer said, ridiculing Republicans for treating repeal like a “hot potato” that can be passed between the chambers.
The GOP’s last-ditch plan underscores the litany of hurdles Republicans have faced in fulfilling their seven-year push to kill Obamacare. House lawmakers passed their bill after a series of false starts, hoping the Senate would strengthen the bill.
Senators wrote their own plan but barely got the chance to vote on it, relying on Vice President Mike Pence to break a 50-50 stalemate this week and begin debate.
The replacement plan that Mr. McConnell fine-tuned for weeks failed, and then a “clean repeal” that got through Congress in 2015 failed, 45-55, on Wednesday.
Seven Republicans voted against the repeal bill, including six who’d voted for it just two years ago, frustrating fellow Republicans who campaigned on the plan.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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