Senate takes a deep breath on health care bill

The U.S. Senate has postponed a vote on its health insurance reform bill until after the July 4th holiday. There were just too few affirmative votes among Republicans for the Better Care Reconciliation Act to make it to the floor.

Leaders were hoping to get the legislation passed before insurers like Premera announce their insurance prices for the coming year, something they are expected to do in July.

Conservatives and moderates had various reasons to balk at even bringing it to the floor for debate.

Sen. Lisa Murkowski of Alaska, a moderate, said she wasn’t ready to vote on the BCRA because she was still trying to learn the impacts it would have on Alaska.

“I need to understand really what we’re talking about, with some of the conclusions that we saw yesterday with the CBO [Congressional Budget Office] score,” Murkowski told reporters. “Taking the time to get it right is where we should be.”

As for Murkowski, she wants these rather large Obamacare  items retained:

• Prohibitions on discrimination for pre-existing conditions
• No annual or lifetime limits
• Coverage for dependents up to age 26
• Continuation of coverage afforded under Medicaid Expansion
• Maintaining access to Planned Parenthood facilities

Murkowski has proposed several other ways to lessen the burdens created by Obamacare:

• Full repeal of the Cadillac Tax; (the Senate in 2015 delayed implementation of the Cadillac Tax — a tax on good health insurance policies — for two years)
• Improving cost transparency of medical procedures;
• Re-evaluating special enrollment periods to close potential loopholes;
• Expanding both Health Savings and Flexible Spending Accounts;
• Incentivizing people to live healthy lifestyles, in order to prevent and bring down the incidence of chronic diseases;
• Supporting the Family Health Care Accessibility Act, improving the services provided by community health centers by enabling them to utilize volunteer primary care providers;
• Supporting the Medicare Patient Empowerment Act, giving patients the option to negotiate the difference between an ongoing Medicare rate and the physician’s fees and providing the flexibility to increase access to care

The current version of the Senate bill repeals the individual mandate to carry health care coverage, but there are still some penalties for people who do not keep their coverage and those penalties are meant to act as a disincentive for people to drop coverage when they are healthy and then re-enroll again when they are sick. The BCRA also repeals the employer mandate for businesses that have 50 or more employees to offer coverage, another significant reform.

BCRA repeals most Obamacare taxes and rolls back the expansion of Medicaid for those states who accepted the federal expansion. Gov. Bill Walker was one of those governors who allowed expansion of Medicaid — albeit in a questionable way, without authority from the legislature — to cover working age adults with no children who are at or above 138 percent of the federally established poverty level.

The BCRA allows people up to age 26 to remain on their parents’ plans and bars insurers from denying insurance to those with pre-existing conditions, both of which are items on Sen. Murkowski’s must-have list.

The bill still has a lot of similarities to Obamacare, but does roll back some of the worst provisions (e.g., the individual mandate, the special taxes and the out-of-control Medicaid expansion). For conservative Republicans, who desire a much more market based system, these partial measures are highly problematic and very disappointing. Indeed, criticism has been unrelenting from both liberal Democrats and conservative Republicans.

Those who opposed Obamacare back in the day knew that once it was in place, it would be nearly impossible to fix, because once you hook people on a certain government-paid benefit — whether it’s an “Obama phone” or wage-based insurance subsidies — it’s hard to unwind because it creates a new class of dependent voters with something to protect. Senate Republican leaders are trying to thread that needle, finding enough consensus within a slim Senate majority to pass a bill that makes some progress but still leaves much to be desired.

Murkowski was a “no” vote on Obamacare when it passed in 2010, and Sen. Mark Begich, whom voters retired in 2014, was a “yes” vote.

At least six Republicans — Sens. Susan Collins and Dean Heller, both moderates with Murkowski, and Sens. Ron Johnson, Rand Paul, and Mike Lee, conservatives — said today they were not ready to vote on the bill and several other senators were undecided.

ALASKA’S HIGH COST OF CARE

“The American people know that Obamacare is failing, literally collapsing before our eyes,” said Vice President Mike Pence today.

For Alaska, a fix can’t come too soon, but to be any help to Alaskans, it is going to have to lower the amount people must pay for insurance and contain no mandates.

In 2013, the average premium for the individual market in Alaska was $344 per month.

By 2017, that amount had risen to $1,041, nearly $700 more per month than before Obamacare. It’s crippling for entrepreneurs and others who make too much to qualify for government subsidies.

The coverage mandates are also driving up premiums for workers in the private sector under qualified plans, hurting nearly all non-government employees in Alaska to the tune of hundreds of dollars per month, sapping discretionary income from other sectors of the economy.

Premera, the only company left doing business in the Alaska Individual health insurance market, has not released its rate request for 2018. Not for Alaska, anyway. In the past, Premera has filed its rate changes in May, but the federal government has given the company until July.

Senators may rewrite the bill but they cannot delay forever. With Republican control of the House, Senate and Executive Branch, they’ll lose their window of opportunity if they do not come to an agreement. And it’s likely if they don’t take action, President Donald Trump will let Obamacare fail under its own weight.

In an interview in March with The Washington Post, Trump said, “The best thing politically is to let Obamacare explode.”

The fact that it is the law of the land is on the Democrats, he said, and “when people get a 200 percent increase next year or a 100 percent or 70 percent, that’s their [Democrats’] fault.”