In the U.S. Senate, Republicans released a draft of their health care bill Thursday. Sen. Lisa Murkowski wouldn’t say how she’ll vote on it, but the draft has elements she has said she’s against, like shrinking Medicaid expansion and defunding Planned Parenthood.
Murkowski said late Thursday afternoon she hasn’t had a chance to read the bill.
“I’m not drawing any lines in the sand until I read what’s contained in this draft,” Murkowski said, adding that she also intended to talk to people at the state and those doing the serious number-crunching.
Murkowski said on the one hand, the tax credits seem better for Alaska than what’s in the House bill, because they are based in part on the prevailing insurance costs, and Alaska’s are the highest in the nation.
On the other hand…
“We’ve got a discussion draft … that has, based on what I’ve been told, a lot of things that cause me concerns,” Murkowski said.
The Senate bill, for instance, ramps down federal funding for expanded Medicaid. Murkowski promised in her speech to the Alaska Legislature this year that she wouldn’t vote to repeal the expansion so long as Alaska leaders want to keep it. Some 34,000 Alaskans are now insured due to that expansion.
Murkowski said she’s heard different views of what exactly the Senate bill means for Medicaid expansion.
“So again: devil is in the detail,” Murkowski said.
For all of Medicaid, the bill would leave states on the hook for more of the costs, as would the House-passed bill. A state-funded report estimates the House bill would cost the state $2.8 billion in Medicaid funds over six years.
The Senate bill would also suspend government insurance reimbursements to Planned Parenthood for a year. Murkowski said in Juneau she wouldn’t vote to deny Alaskans access to the health care services Planned Parenthood provides.
For Alaskans who buy their insurance policies on the exchange, the Senate bill keeps the subsidies but lowers the income threshold for eligibility. So, a 50-year-old Alaskan earning $59,000 a year now qualifies for about $10,000 in annual subsidies. Under the Senate bill, that person would get no subsidy, though people earning less than about $52,000 would still be eligible.
The bill repeals most of the taxes the Affordable Care Act imposes, like the taxes on tanning beds, medical devices and investment income. But it keeps the ACA’s so-called Cadillac Tax, which would have outsized impact on Alaska. It’s intended to apply only to deluxe, high-premium insurance plans. But in Alaska insurance costs a lot more, so the Cadillac tax would apply to average employer-funded plans. Both Alaska senators sponsored a bill to repeal it. The Senate’s insurance reform bill delays the Cadillac tax until 2026.
Murkowski is considered a moderate swing vote. Several conservative Republicans have already announced they can’t vote for the bill in its current form because it doesn’t repeal enough of the ACA.
The Senate bill has $50 billion over four years to stabilize the ACA’s insurance marketplaces, but it’s not clear how the money would be distributed.
Sen. Dan Sullivan, like a lot of senators, said he’s still reviewing the bill. His office responded to an interview request by sending a video he recorded before the draft bill emerged.
In it, Sullivan gave something of a defense for the secretive process Senate leaders employed to craft the bill. The senator said they could have been more open, but he said the stakes are high.
“Something has to be done, and it has to be done soon,” Sullivan said.
Becky Hultberg, president of the Alaska State Hospital and Nursing Home Association, said her members are concerned the Senate bill will leave too many Alaskans uninsured and the state unable to pay the increased costs of Medicaid, although she acknowledges Alaska has some serious problems under current law.
“But the answer to those problems is not simply shifting costs and reducing coverage, and that essentially is what this bill does,” Hultberg said.
The Congressional Budget Office is expected to produce its analysis of the bill early next week, ahead of the Senate vote.