When the Senate began work on its health-care bill, there was hope that they might produce something more popular than the House bill, which was disliked even by people who voted for it. As New York’s Ed Kilgore noted, Majority Leader Mitch McConnell didn’t need to come up with better legislation, he just needed to make it look like he’d made some improvements:
Senators very much need their bill to be perceived as much less damaging to the American health-care system than the House bill. But at the same time, it needs to be close enough in reality to the House bill that the ultimate House-Senate conference product can still get through the lower chamber.
So, does the Better Care Reconciliation Act accomplish this? Currently, the answer is no. Many were quick to point out that just like the House bill, the Senate version isn’t about health; it’s about shifting money to the wealthiest Americans by forcing poor people to pay more for less health care.
But it’s early, and McConnell seems to be betting that opinions will change rapidly. As Jonathan Chait explained, the idea is that if McConnell starts with a cruel, massively unpopular piece of legislation, small concessions will get disproportionate attention. Suddenly, the story will be that the Senate improved its health bill, not that the underlying legislation is horrific.
For the time being, however, we’re still at the stage where people from across the political spectrum pan the bill. Here’s a guide to everyone who’s unhappy with the legislation — and the handful who are excited to be closer to rolling back Obamacare.
Those Who Dislike the Senate Health Bill
Americans Who Require Health Care, and Their Loved Ones
If you’re a member of one of the 400 wealthiest families in America, the GOP health plan is going to save you about $7 million annually in taxes. If you’re a poor, disabled, or older person on Medicaid; a poor person who doesn’t qualify for Medicaid; an opioid addict; a pregnant woman; a child in a special-education program; or a Planned Parenthood patient, you should be prepared to lose access to care, or at least pay much more for it, as Vox reports.
People Who Passed Historic Health Legislation That Bears Their Name
President Obama restrained himself from publicly commenting on every troubling development during the early days of the Trump administration, but on Thursday he posted a lengthy Facebook message criticizing the Senate health bill. He said, “If there’s a chance you might get sick, get old, or start a family — this bill will do you harm.” He said even tweaks to the bill “cannot change the fundamental meanness at the core of this legislation.” He continued:
I recognize that repealing and replacing the Affordable Care Act has become a core tenet of the Republican Party. Still, I hope that our Senators, many of whom I know well, step back and measure what’s really at stake, and consider that the rationale for action, on health care or any other issue, must be something more than simply undoing something that Democrats did.
An admonishment from President Obama seems unlikely to dissuade Republicans from their secondary goal of undoing his legacy, but it was worth a try.
Four of the most conservative members of the Senate — Rand Paul, Ted Cruz, Ron Johnson, and Mike Lee — were quick to put out a statement on Thursday saying they could not vote for the bill in its current form. Their basic complaint is that it doesn’t go far enough in reducing benefits and subsidies for the poor.
“It’s going to be hard for conservatives to support a bill that has greater subsidies than Obamacare,” Kentucky senator Rand Paul told reporters. “I didn’t run on Obamacare Lite.”
Confusingly, these senators may not be the Republican lawmakers most passionately opposed to BRCA. Paul has been complaining that the GOP plan is insufficiently conservative for months, and it seems likely that he’s a hard “no” (it’s worth noting that the Medicaid expansion is quite popular in his home state of Kentucky). It seems the others are complaining as a negotiating tactic. It’s hard to image Cruz wants to go down as the senator who saved Obamacare.
Still, their stand against the bill does endanger its passage, as pushing it too far to the right could alienate GOP moderates who take issue with depriving millions of their health coverage. Three Republicans — Susan Collins, Dean Heller, and Rob Portman — said they have “concerns” about cuts to Medicaid, but they’re still reviewing the bill. Collins said in a statement that she “will be particularly interested in examining the forthcoming CBO analysis on the impact on insurance coverage, the effect on insurance premiums, and the changes in the Medicaid program.”
McConnell can only afford two GOP defections, and by the New York Times’ count another 28 Republicans were noncommittal on Thursday.
Governors of States That Took the Medicaid Expansion
There were 31 states that accepted Obamacare’s Medicaid expansion, which added 11 million people to the ranks of the insured. Both Democratic and Republican governors from these states spoke out against the Senate bill.
“It appears that the proposed bill will dramatically reduce coverage and will negatively impact our future state budgets,” said Nevada governor Brian Sandoval, a Republican.
“I have deep concerns with details in the U.S. Senate’s plan to fix America’s health care system and the resources needed to help our most vulnerable, including those who are dealing with drug addiction, mental illness and chronic health problems and have nowhere else to turn,” said Republican Ohio governor John Kasich.
Right-leaning opinion leaders were not universally opposed to the bill (Avik Roy said, “If it passes, it’ll be the greatest policy achievement by a GOP Congress in my lifetime”), but some on the right were unenthusiastic:
Health Care Providers
Several medical groups slammed the legislation, including the American Academy of Pediatrics and American Hospital Association.
“The bill that the Senate unveiled today was crafted without the benefit of groups like pediatricians weighing in with what children need,” said Dr. Fernando Stein, president of the AAP. “The result is that the bill would tear down the progress we’ve made by achieving health insurance coverage for 95 percent of America’s children.”
The bill is a mixed bag for health insurance companies. As Vox notes, there are some big upsides for insurers:
It repeals Obamacare’s tax on health plans, a $144 billion tax cut over 10 years, per an analysis of the House bill. It provides $50 billion in federal funding in the short term to shore up the private insurance market and $62 billion over the longer term for state programs that help stabilize their insurance markets.
However, there’s no insurance mandate, which could lead to young, healthy people going without coverage, and the huge cuts to Medicaid could be devastating to certain insurers. “These numbers are staggering,” Pamela Morris, chief executive of CareSource, a Medicaid-focused insurer, told The Wall Street Journal.
Those Who Like the Senate Health Bill
There are a few people who are excited about BCRA, even without any tweaks. Seventeen Republican senators have already said they intend to vote for it. “It’s much better than Obamacare,” said Senator David Perdue.
In the Trump administration, HHS Secretary Tom Price seemed the most excited. “The Senate’s proposal is built on patient-centered reforms that put the American people in charge of their healthcare decisions, not government, protecting patients, bringing down the cost of coverage, and expanding choices,” he said. “The Trump administration is committed to the health of all Americans.”
The president himself was in a less celebratory mood. He recently called the House bill “mean,” and on Thursday afternoon White House spokeswoman Sarah Huckabee Sanders said that he was “pleased to see the process moving forward swiftly in Congress, and he looks forward to seeing a finalized bill on his desk.”
Later Trump took to Twitter to assure everyone that he really is in favor of the bill, and looks forward to making the process of depriving millions of health insurance “really special.”