WASHINGTON — Senate Republican leaders added new language to their health care bill Thursday to allow the sale of cheap, bare-bones insurance plans in an attempt to draw enough conservative support to pass the measure to replace Obamacare.
At the same time, the bill gives moderates more of what they want by increasing funding to fight opioid addiction from $2 billion in the original bill to $45 billion in the latest draft.
However, two Republicans — moderate Sen. Susan Collins of Maine and conservative Sen. Rand Paul of Kentucky — said Thursday they will not even vote for a procedural motion to allow a vote on the health care bill next week.
Collins tweeted that there are "still deep cuts to Medicaid in Senate bill" and said she wants to work with senators of both parties to "fix flaws" in the Affordable Care Act, better known as Obamacare.
Senate leaders cannot lose more than two of the chamber's 52 Republicans or they won't be able to pass the bill, which is opposed by Democrats.
The draft bill, released on the Senate Budget Committee's website, tries to appeal to conservatives by including a version of an amendment by Sens. Ted Cruz, R-Texas, and Mike Lee, R-Utah, that would allow the sale of deregulated insurance plans as long as Obamacare-compliant plans are also still sold.
Cruz confirmed to reporters Thursday that his amendment is in the bill and called that "very significant progress." But he stopped short of saying whether it would be enough for him to support the legislation.
"It is also very significant that the bill includes my amendment to allow individuals to use health savings accounts to pay for premiums," Cruz said. "That's a big deal for lowering premiums."
Insurance companies have strongly opposed the Cruz amendment, saying it would cause more instability in the marketplace. Supporters of the plan say it will give consumers the option to choose the right plan for their lifestyle. But critics say older and sicker Americans will end up paying much more for their more robust coverage.
The revised proposal would continue the Affordable Care Act's taxes on high-income earners to help subsidize care for lower-income Americans.
It also provides an additional $70 billion to help states lower the cost of insurance for their residents through cost-sharing plans or allowing people to use Health Savings Accounts to pay for their premiums. That money would be added onto the $112 billion in the original bill.
There would be more options for Americans to buy lower-cost plans in addition to costlier plans that provide more coverage and lower deductibles.
Anyone in the individual market would be allowed to buy a lower-cost plan. These plans would have higher deductibles than plans currently provided under Obamacare. They would cover three primary care visits a year and have some protections to limit out-of-pockets costs.
The bill would reduce the amount of federal Medicaid funds provided to states beginning in 2021 while continuing coverage for children with "medically complex disabilities." It allows states to choose between block grants and per capita allotments for low-income residents who receive Medicaid.
"This is our opportunity to really make a difference on health care," Majority Leader Mitch McConnell, R-Ky., said Thursday in a speech on the Senate floor. "Failure to act means more families get hurt by Obamacare as it continues to collapse. It also means the law’s problems will grow more formidable, making them even harder to solve ... So it’s time to rise to the occasion."
It was still not clear Thursday afternoon whether the changes would attract enough votes to pass the legislation, which Republicans are calling the Better Care Reconciliation Act.
Key moderate Republicans such as Sens. Dean Heller of Nevada, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia said they needed to take a close look at the bill's details before saying whether they could support it. All of them opposed the earlier version of the legislation.
Murkowski expressed irritation that reporters and lobbyists had seen the new bill before many GOP senators had.
"I think that as a courtesy to those of us that are making decisions that we would actually have an opportunity to see it first," she told the clutch of reporters who mobbed her for comment. "I haven't seen it."
About 10 GOP senators opposed the initial Republican bill that was unveiled last month, and McConnell scrapped a planned vote at the end of June.
Democrats have been united in opposing the bill, calling on Republicans to instead work with them to try to fix problems with the existing Obamacare system.
McConnell hopes to hold a vote on the revised bill next week, after the nonpartisan Congressional Budget Office releases a new analysis of what it will cost and how many people it would insure. The bill's supporters must first get 51 votes on a motion to proceed to the bill before a vote is taken on the actual legislation.
Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., offered an alternative Thursday that they said could help attract 50 votes if the latest proposal from GOP leaders doesn't.
Graham and Cassidy said the goal was not to undercut McConnell's plan, but to offer another option.
Their plan would leave taxes on wealthy individuals in place and send the current federal funding for Obamacare, estimated at about $110 billion last year, to the states in the form of block grants that governors could use however they want. Graham said states could keep Obamacare in place or replace it with a new system.
"Instead of having a one-size-fits-all solution from Washington, we should return dollars back to the states to address each individual state’s health care needs," Graham said. "Just like no two patients are the same, no two states’ health care needs are the same ... The state would have a pot of money from the federal government to get the best health care outcomes for their residents."
Sen. Ron Johnson, R-Wis., who opposed last month's version of the GOP health care bill, said the Graham-Cassidy alternative "actually has some appeal to me."
"I just don't like a federal definition of health insurance," he said in explaining why he might support the amendment.
He said he is leaning toward voting in favor of a final bill next week unless there is something "awful" in it.
Senate Minority Leader Chuck Schumer, D-N.Y., said the latest version of the GOP health care bill is "even meaner" than the original, in part because the Cruz-Lee amendment lowers premiums by creating huge increases in deductibles and co-pays.
"Out-of-pocket expenses would actually go up, not down," Schumer said.
He also said "it appears little has changed at the core of the bill." The legislation still slashes Medicaid, hurting rural hospitals, Americans in nursing homes and opioid addicts who use Medicaid to pay for treatment programs, Schumer said.
Democrats also complained that the bill still defunds Planned Parenthood, cuts taxes on insurers and imposes higher costs on Americans in their 50s and 60s who aren't old enough for Medicare.
"So what's new?" Schumer said. "It appears there is a new $60 billion tax break on Health Savings Accounts, which only benefits those wealthy enough to pay for them."
A Health Savings Account allows people to save money tax-free to use to help pay for insurance policies with high deductibles.
Contributing: Deirdre Shesgreen