When it comes to the “discussion draft” to replace Obamacare that U.S. Senate Republicans unveiled Thursday, Missouri’s two senators could not be farther apart.
Republican Sen. Roy Blunt praised the measure, claiming it would address the “disaster” that is Obamacare, the name by which the Affordable Care Act is commonly known.
Democratic Sen. Claire McCaskill blasted the bill, saying it’s “exactly what you’d expect when the future of health care gets negotiated in a secret backroom deal. You get a bill that hikes costs for working families, strips protections from Missourians who’ve been sick before, and slices critical resources for rural health care and anti-opioid efforts.”
The divergent responses reflect the diametrically opposing views of the two parties: Republicans are determined to get rid of Obamacare; Democrats want to preserve and fix it.
Blunt told Joplin radio station KZRG on Thursday that the individual health insurance market under Obamacare was “imploding” and pointed to premiums that have risen 145 percent in Missouri’s individual marketplace since 2013.
“It’s like you’re in a collapsing building and trying to build something new,” he said.
He also noted that 97 counties in Missouri have only one insurer offering health insurance in the individual marketplace and 25 will have no insurer next year following Blue Cross and Blue Shield of Kansas City’s decision to pull out.
McCaskill, rather than getting rid of Obamacare, wants to address the “bare counties” problem with legislation that would allow individuals in those counties to access the same insurance available to members of Congress and their staff.
“Current health care law needs to be fixed, no question about it — and I’ve proposed specific legislation to help fix it,” she said in a statement Thursday. “But the bill announced today is a disaster for Missouri that seemingly only benefits insurance companies and the very wealthy.”
The Senate measure differs in some details from the bill passed by the House last month, but it takes the same general approach: enacting massive cuts to Medicaid, which provides health coverage to one out of every five Americans; phasing out the expansion of Medicaid under Obamacare; abolishing the mandate requiring most people to purchase health insurance; and eliminating the tax increases on wealthy Americans that helped fund Obamacare.
It would also reduce the tax subsidies now available to help people buy health insurance, instead providing federal tax credits pegged to people’s income.
Dave Dillon, a spokesman for the Missouri Hospital Association, says some of the Senate bill’s provisions would add coverage that Missourians don’t have right now.
“There are components of it that would provide similar incentives for individuals in the health insurance marketplace up to 350 percent of the federal poverty level, which could bring a lot of lower-income folks into commercial insurance,” he says.
On the other hand, he says, “what we’re seeing is there isn’t a lot of good news for the Medicaid program, which provides essential care not only to low-income working folks under the Affordable Care Act, but also to blind individuals, individuals with disabilities, the aged, especially in nursing home care.
“The funding for Missouri during the implementation period is going to be very difficult for a state that, on a current basis, struggles to pay its Medicaid bill every year,” Dillon says.
Blunt told the Joplin radio station that “no Missourian would lose any Medicaid under anything we’re talking about.”
But given the extent of the cuts contemplated by the Senate measure, health policy experts and state officials say it’s inevitable that people will be cut from the Medicaid rolls because states simply would not be able to make up the loss of federal Medicaid funds.
“It would transform the entitlement program from an open-ended system to a capped model,” says Kansas City Rep. Emanuel Cleaver, who calls the Senate bill more a tax measure to benefit the wealthy than a health care bill.
“Because it’s obvious the decisions were made to cut taxes for the wealthy, and some of it is so transparently unfair that I thought they’d be ashamed to introduce it,” he says.
The bill, which was crafted behind closed doors by 13 Republican senators, has yet to be analyzed by the nonpartisan Congressional Budget Office, which said the House version would leave 23 million more people uninsured than under Obamacare. The CBO said it would score the Senate measure next week.
The bill will then be open to debate and subject to amendments. After that, the Senate will move for final passage and a vote.
Assuming Democrats remain unified in their opposition, Republicans, with their 52-48 majority, can afford to lose only two votes under the arcane budget rules that would allow them to avoid a Democratic filibuster. If they get 50 votes, Vice President Mike Pence would break the tie.
Dan Margolies is KCUR’s health editor. You can reach him on Twitter @DanMargolies.