Almost nobody knows what the Senate’s health care plan will look like because it has been drafted behind closed doors with no public hearings, no copies for anyone to see and no updates on what it might contain.
The other thing nobody knows is whether it has a future.
One of the people who may decide its fate is Sen. Susan Collins, a Maine Republican who is unhappy with the process but won’t rule out voting for the measure if it ever sees daylight.
Without knowing what the proposal contains or what the Congressional Budget Office says about it, she said Wednesday, it’s impossible to know yet whether it ought to pass.
Collins said she has many concerns about different elements that may be included in the bill and has staffers preparing possible amendments to bring it more in line with her thinking, if necessary.
Her counterpart from Maine, independent Angus King, is dubious about what the GOP is doing.
King said the GOP’s rushed and secretive process for developing a health care bill in the Senate “frankly stinks.”
“All of the pieces on this are wrong, and it’s being done in the wrong way,” he said Wednesday. “We can do better around here. We can openly debate and discuss and take some time and understand what the ramifications are, but to vote for a bill like this without fully appreciating the consequences? I don’t get it,” King said in a video posted on Facebook.
“It’s not a good way to legislate,” Collins said, adding it doesn’t help restore the public’s confidence in government.
Collins didn’t like the House bill passed last month — one that President Donald Trump hailed with a party at the White House before reportedly declaring it was “mean” — and frets about what a Senate counterpart might include.
Trump wants “a bill that has heart in it,” his press secretary, Sean Spicer, said Tuesday without explaining what that might entail.
What is clear, though, is that if the GOP loses just three of the 52 Republican senators, who have a wide range of opinions on what a health care revision ought to look like, then there won’t be a successful vote on the plan. An even split at 50-50 is good enough because Vice President Mike Pence would get to cast a tiebreaker.
The key to pulling together a successor for President Barack Obama’s Affordable Care Act is finding a way to put in enough to attract moderates such as Collins without losing diehard conservatives who mostly just want to repeal Obamacare.
Collins said she anticipates receiving the bill’s language Thursday, a Congressional Budget Office evaluation as soon as Friday and a vote on the measure in the wee hours Friday, June 30, beating Majority Leader Mitch McConnell’s July 4 deadline for action.
Democrats, who uniformly oppose the measure, have declared their intention to use every possible parliamentary trick to stymie the process.
“If the GOP continues to insist on ramming through a secret health care bill without any public input, they shouldn’t expect business as usual,” Minority Leader Chuck Schumer of New York said in a statement on Twitter.
The Maine Democratic Party called on Collins “to take a stand. Say you won’t vote for any health care bill written behind Mainers’ backs.”
Collins said, though, that she’s not going to oppose the bill solely because of her distaste for the way it was drawn up. She said there should have been hearings, input from experts and a chance for public debate.
But, Collins said, she’s determined to try to read the bill, analyze it, study “the all-important CBO report” and then figure out if the proposal will improve health care for Mainers and the nation.
King said he is “not optimistic” about the Senate bill and concerned that senators may only have hours to digest it before they’re called on to vote one way or another.
Rep. Chellie Pingree, a 1st District Democrat in Maine, said in a Facebook post Tuesday that “even though this legislation will affect each and every American, Senate Republican leadership has gone to unprecedented lengths to keep their negotiations secret. We don’t know when we’ll be able to read the bill.”
“No hearings, no markups, no bipartisanship. You deserve better. You deserve to know how these backroom decisions stand to impact the health and livelihood of your family,” Pingree said.
Nearly every major health care group, including the Maine Hospital Association, is opposed to the revisions eyed by the Republicans.
The Commonwealth Fund said that Maine would lose 10,000 jobs and shave almost $1 billion off the value of its economy by 2026 under the American Health Care Act approved by the House. Whether the Senate’s version will be better is unknown.
King said hospital executives in Maine have warned him that if something like the House bill ultimately passes, they’ll have to lay people off and perhaps close some hospitals.
Collins said she’s met with Maine consumers, health care providers, insurers and others who have raised many issues and worries, most of them based on the House version of the bill adopted before the Congressional Budget Office even weighed in on its impact.
Collins, who said she was stunned the House voted on the bill before it saw the Congressional Budget Office report, castigated its bill after budget analysis found it would cause 23 million more Americans to go without insurance a decade from now. She also decried its impact on some whose premiums would soar.
But she also expressed concern that health insurance markets for individuals “are in danger of collapsing in many states,” costs are rising and 28 million Americans remain uninsured.
She said Wednesday that she went with a group of senators to McConnell on Tuesday to make sure he knew of their worry that failing to use an adequate inflation adjustment for Medicaid funds to states would create problems.
The senator said she’s concerned the bill could hurt states such as Maine that have lower than average costs for some Medicaid items because of the efficiency of its program. If the adjustments aren’t high enough, Maine would be among the states that could wind up seeing shortfalls that lead to cuts in eligibility, reduced services or less coverage, Collins said.
It’s a technical issue, she said, but one that “has enormous ramifications.”
Slicing Medicaid could also make it difficult for opioid addicts who are counting on Medicaid for health exchange insurance to cover the treatment they need to free themselves of their addiction, Collins said. That could have “a devastating impact,” she said.
One of the problems with having a bill-writing process where “very few people” are privy to the language, Collins said, is that it’s hard to know any particulars.
Collins said one of the things she’s most eager to find out is what the impact of the Senate bill would be on Mainers who are 55 to 64 years old, on the verge of retirement but not yet eligible for Medicare. The House bill would push up some of their premiums by 800 percent, she said, making insurance unaffordable for “a particularly vulnerable group.”
She said she’s also worried about what happens to lower income people within 250 percent of the poverty line who qualify for subsidies under Obamacare but could find themselves facing costs that would basically leave them uninsured.
Among the other potential changes that Collins is worried about is a possible restoration on lifetime and annual caps that would make some people run out of insurance if they have costly medical conditions. She’s also concerned about children with expensive health issues that may carry on through their lives.
“There are so many questions,” Collins said, and perhaps very little time to get answers.
“I don’t want to miss something,” she said. “It’s a very difficult situation.”