Senate Majority Leader Mitch McConnell yesterday unveiled a new draft of the Senate’s plan to repeal and replace the Affordable Care Act (ACA). The bill contains steep cuts to Medicaid and an amendment that would pretty much gut the ability of anyone with a pre-existing condition to afford a policy on the individual market. So who’s opposed? Pretty much everyone, it seems — except the 50 people whose opinions matter most.
A growing majority of Americans hate it
The non-partisan Kaiser Family Foundation, a non-profit focusing on national health and health policy issues, has for many months run a survey tracking Americans’ shifting opinions on the ACA and Congressional plans to replace it.
The most recent poll finds that 61% of Americans overall hold unfavorable views on the current plans to repeal and replace the ACA with something else.
Those opinions do vary by both party identification and Trump support — but at the nitty gritty level, Americans overall oppose the details in the plans, regardless of party.
65% of Americans, for example, oppose the major cuts to Medicaid included in the bills — and that includes roughly half of all Republicans and those who say they support President Trump.
71% of respondents, KFF says, would rather see Congress stop what they’re doing and take a bipartisan approach instead of the hard party-line tactics Congressional leaders are using right now. Even among respondents who identified as Trump supporters, sentiment is split. Nearly equal numbers of Trump supporters feel that Congress should double down and keep going on its repeal plan (47%) as feel that Congress should change course and do something bipartisan (46%).
The KFF also found that more respondents support the current ACA (50%) than support a plan to repeal and replace it (28%).
That’s in line with what previous surveys from the non-partisan Pew Research Center have found. In February, Pew polling found that 54% of Americans outright approved of the ACA.
As the KFF notes, opposition to the Congressional plans to repeal and replace have only grown over time:
And so do hospitals, doctors, and insurers
But of course, the “man on the street” has a lot of opinions; maybe not all of them should shape policy. So what do the experts think? They hate it, too.
Non-partisan organizations like our siblings at Consumer Reports and the Center on Budget and Policy Priorities have stated opposition to the bill, but so do the organizations representing the folks who actually provide and pay for health care.
The American Medical Association — the nation’s largest doctors’ group — said today that the new bill “does not address the key concerns of physicians and patients,” and that the Medicaid cuts and “inadequate subsidies” will lead to “millions of Americans losing health insurance coverage.”
The American Hospital Association and Federation of American Hospitals both openly opposed the previous version of the bill, thanks to its drastic Medicaid cuts. As the current version of the bill retains those cuts, neither is likely to become suddenly in favor.
That also goes for the American Public Health Association, which blasted the Medicaid cuts in the first draft.
Following the money also leads to opposition. Health insurers, of course, make billions upon billions of dollars on managing Americans’ access to healthcare. But as Politico reports, the nation’s largest insurers and the lobbying group that represents them are voicing concerns about the new draft.
In a letter sent to Senators Ted Cruz (TX) and Mike Lee (UT) this week, Blue Cross Blue Shield Association CEO Scott Serota said that their plan was “unworkable,” because it would “undermine pre-existing condition projections, increase premiums and destabilize the market.”
That sentiment was echoed by America’s Health Insurance Plans (AHIP), the trade and lobbying group that represents dozens of large and small insurers (including all the big national ones except United).
In a memo [PDF], AHIP writes that “this proposal would fracture and segment insurance markets into separate risk pools and create an un-level playing field that would lead to widespread adverse selection and unstable health insurance markets.”
But Senators matter most
Nearly all of the Democratic Senators have put out statements condemning the bill, but of course nobody expected them to vote for it anyway. Several Republican governors, like Ohio’s John Kasich, have also issued statements opposing the bill.
But the opinions that truly matter are those of the 52 Republicans in the Senate.
The bill needs 50 Senators to vote for it in order to pass, because Vice President Mike Pence can be a tie-breaking fifty-first vote as needed. That means up to two Republicans can oppose it, but if three choose to vote “no” then it stops.
Sen. Susan Collins (ME) has already stated she will not vote for the bill, as has Sen. Rand Paul (KY). The two are opposed for different reasons — Collins thinks it cuts too far, and Paul thinks basically that it doesn’t cut far enough — but a no is still a “no,” for whatever reason.
That leaves one. But many Senators who had been publicly opposed to the earlier version of the bill have been silent on the new draft — even when it retains, or even doubles down on, the parts to which they had voiced concerns.
As Axios observes, none of the Senators who previously voiced concerns about hanging patients with pre-existing conditions out to dry has as yet voiced an objection to the Cruz amendment, which does exactly that.
Senators Shelley Moore Capito (WV), Dean Heller (NV), John Hoeven (ND), Lisa Murkowski (AK), and Rob Portman (OH) are the “moderate” faction who have have previously expressed concern with the Medicaid cuts in the bill. However, since the new draft was released none have said explicitly yet whether they intend to vote for or against it.
On the conservative end of things, with the exception of Paul, the group of Senators that opposed the first draft of the bill — Sens. Ted Cruz (TX), Ron Johnson (WI), and Mike Lee (UT) — all seem much more receptive to the new draft, and are likely to support it.
Outside of Collins and Paul, in fact, Republican Senators have by and large been very quiet as to their feelings on the bill, and are considered increasingly willing to vote in its favor.