Health Politics

Kentucky Sen. Rand Paul is slamming efforts led by Senate Majority Leader and fellow Kentuckian Mitch McConnell to repeal and replace the Affordable Care Act. 

Paul said he won’t know how he will vote until the bill is released to legislators on Thursday, but he anticipates that McConnell won’t have the votes and will have to renegotiate the legislation with members of his own party.

“Conservatives who are in the know are going to know that this isn’t repeal,” Paul said Tuesday, according to Bloomberg News reporter Sahil Kapur. “And no Democrat likes it because they think it’s going too far. So I think you’re going to wind up with what you had in the House bill — about 20 percent of the public’s going to think it’s a good idea.”

Paul is not one of the 13 senators chosen by McConnell to draft the bill. He fiercely opposed the House version, and McConnell likely won’t look to him for support, which means he’ll need almost every other Senate Republican to vote in favor of the measure.

McConnell and a small group of Senate Republicans have been working on the measure behind closed doors for weeks, keeping the bill — and negotiations — from public view.

Meanwhile, Senate Democrats on Monday evening began using parliamentary maneuvers to slow the chamber’s business and call attention to the secret meetings, as reported by NPR.

“Republicans are drafting this bill in secret because they’re ashamed of it, plain and simple,” Senate Minority Leader Chuck Schumer told reporters Monday night. “These are merely the first steps we’re prepared to take in order to shine a light on this shameful Trumpcare bill and reveal to the public the GOP’s true intentions: to give the uber-wealthy a tax break while making middle class Americans pay more for less health care coverage.”

In a speech on the Senate floor Monday evening, McConnell said he was disappointed that Democrats haven’t partnered with his party on efforts to replace Obamacare.

The Senate version of the bill, according to reports, is similar to the House version but with a bigger window to phase out Medicaid expansion and more funds for tax credits to purchase health insurance.

“I expect to have a discussion draft on Thursday and we will go to the bill obviously once we get a CBO score — likely next week,” McConnell told reporters Tuesday.

That draft legislation will only go to senators and reporters, he said.

McConnell has been tight-lipped about the drafting process, allowing the measure to be made public only a few days before the Senate is expected to vote on it. That could happen as soon as next week — which would be very close to McConnell’s self-imposed deadline of July 4.

Some Senate Republicans, including Bob Corker from Tennessee and Senate Finance Chairman Orrin Hatch of Utah, are skeptical about a vote happening that soon. Corker has said Medicaid reforms continue to be the source of disagreement among members.

If the Senate bill is similar to the House version, it would only allow people with pre-existing conditions to keep coverage if there are no lapses between insurance policies; otherwise, insurers would be allowed to deny them coverage, erasing a key provision of the ACA. The bill would also take away coverage from people with Medicaid making between $11,000 and $15,000 a year, who were covered under Obamacare. 

Other potential sticking points that could make it difficult to get a measure passed include:

  • Phasing out Medicaid expansion over three years
    Decreasing the amount states get for Medicaid enrollees
    How much to give people in the form of tax credits to buy health insurance
    How to pay for those tax credits

The Senate must have the nonpartisan Congressional Budget Office provide a cost estimate for the measure 28 hours before a vote can take place. Republicans have been sending pieces of the bill to the CBO, so it’s possible the Senate could have a score early next week.

If the Senate gets the 50 votes to pass its measure, it would be sent back to the House for approval. If the House approves, the measure would go to President Trump for his signature. 

Lisa Gillespie is WFPL's Health and Innovation Reporter.