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Does health insurance coverage really save lives?

In the midst of the complex, politically-charged health care debate unfolding in Washington, medical researchers say the science is clear: being uninsured increases one’s risk of dying.

That’s the headline out of a new big-picture analysis of existing research that explores the relationship between insurance coverage and mortality.

“Losing insurance is lethal and gaining insurance reduces the death rate. That is completely consistent numerically across the different studies,” Dr. Steffie Woolhandler, a professor at the CUNY School of Urban Public Health at Hunter College in New York and co-author of the literature review, told CBS News. “The politicians in Washington need to deal with that as a fact and not pretend there’s disagreement on this issue. There’s not disagreement on this issue if you examine the science.”

The analysis, published Monday in the journal Annals of Internal Medicine, provides an update to a 2002 review of 130 studies on the subject, incorporating additional studies completed since that time. Both then and now, the research shows that people who are uninsured generally have “poorer health and shortened lives.”

“The thing that’s most surprising is how consistent the literature is. There’s really not much disagreement in the scientific literature,” Woolhandler said.

Co-author Dr. David Himmelstein said the reason is simple: “People get to see the doctor or nurse practitioner… and get their health problems taken care of.” For example, “If you don’t have health insurance you’re unlikely to get treatment for your diabetes or your depression.”

How big a difference does having health insurance coverage make?

The studies covered in Woolhandler and Himmelstein’s paper “all suggest roughly the same thing — that insurance has a modest, but real, effect on all-cause mortality. Something to the tune of a 20% relative reduction in death compared to being uninsured,” F. Perry Wilson, M.D., wrote in an analysis for MedPage Today.

In addition to lower overall death rates, the study also cites “other well-established benefits of health insurance: improved self-rated health, financial protection, and reduced likelihood of depression.”

Both authors of the study are affiliated with Physicians for a National Health Program, an organization that advocates for a single-payer health care system covering all Americans.

About 28.4 million Americans are uninsured, according to the latest government figures. If the Senate Republican bill to replace the Affordable Care Act passes, 22 million more people will find themselves without insurance in the next decade, according to an analysis released Monday by the nonpartisan Congressional Budget Office. The bill specifically affects funding for Medicaid, the federal-state health insurance program for low-income Americans.

The latest research directly contradicts a recent claim by Rep. Raúl Labrador, a Republican from Idaho, who said at a town hall last month: “Nobody dies because they don’t have access to health care.”

Video of Labrador’s comments went viral, and the congressman later tried to clarify on Facebook: “I was trying to explain that all hospitals are required by law to treat patients in need of emergency care regardless of their ability to pay and that the Republican plan does not change that,” he posted.

Last week, Sen. Orrin Hatch, R-Utah, pushed back forcefully against Sen. Bernie Sanders’ assertion that “thousands of people will die if the Republican health care bill becomes law,” retorting: “The brief time when we were *not* accusing those we disagree with of murder was nice while it lasted.”

People without insurance often go without preventative services, from pap smears to mammograms to blood pressure checks, as well as treatment for chronic diseases.

For some, the stress of dealing with serious health issues while being uninsured can also take a toll.

“When I didn’t have insurance, I was so much more stressed about the fact that I didn’t have back up behind me, that it actually caused me to have worse symptoms,” Fred Zorn, a patient with inflammatory bowel disease, told CBS News.

For researchers, the relationship between health insurance and mortality is tricky to study. In the U.S., many individuals cycle in and out of coverage over the years, making it difficult to discern the differences in health outcomes between the insured and uninsured. The study points out that ethical considerations prevent doing a randomized clinical trial in which certain people are deliberately kept uninsured. Additionally, the insured and uninsured are not neatly defined groups: for instance, becoming ill often directly causes individuals to qualify for public insurance, losing a job often results in losing insurance, and so on, leading to thorny questions of causality.

Senate Republicans are working overtime to finalize the bill and vote on it before lawmakers leave Washington for the July 4th recess. The bill needs 51 votes to pass, but the leadership has not yet secured enough support.

More than a dozen leading health and medical groups oppose the Senate bill, including the American Medical Association, the American Academy of Pediatrics, the American Lung Association, AARP and the American Hospital Association.

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Senate Health Bill Reels as CBO Predicts 22 Million More Uninsured

But the budget office put Republicans in an untenable position. It found that next year, 15 million more people would be uninsured compared with current law. Premiums and out-of-pocket expenses could shoot skyward for some low-income people and for people nearing retirement, it said.


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The legislation would decrease federal deficits by a total of $321 billion over a decade, the budget office said.

Mr. McConnell, the chief author of the bill, wanted the Senate to approve it before a planned recess for the Fourth of July, but that looks increasingly doubtful. Misgivings in the Republican conference extend beyond just a few of the most moderate and conservative members, and Mr. McConnell can lose only two Republicans.

At least some of Ms. Collins’s concerns could be shared by Senators Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia, whose rural states would face effects similar to those in Maine.

“If you were on the fence, you were looking at this as a political vote, this C.B.O. score didn’t help you,” said Senator Lindsey Graham, Republican of South Carolina. “So I think it’s going to be harder to get to 50, not easier.”

He added, “I don’t know, if you delayed it for six weeks, if anything changes.”

Under the bill, the budget office said, subsidies to help people buy health insurance would be “substantially smaller than under current law.” And deductibles would, in many cases, be higher. Starting in 2020, the budget office said, premiums and deductibles would be so onerous that “few low-income people would purchase any plan.”

Where Senators Stand on the Health Care Bill

Senate Republican leaders unveiled their health care bill on Thursday.

Moreover, the report said, premiums for older people would be much higher under the Senate bill than under current law. As an example, it said, for a typical 64-year-old with an annual income of $26,500, the net premium in 2026 for a midlevel silver plan, after subsidies, would average $6,500, compared with $1,700 under the Affordable Care Act. And the insurance would cover less of the consumer’s medical costs.

Likewise, the report said, for a 64-year-old with an annual income of $56,800, the premium in 2026 would average $20,500 a year, or three times the amount expected under the Affordable Care Act.

The budget office report was a major setback to Senate Republican leaders, but it was too early to declare the legislation dead, and turmoil in health insurance markets could still induce Congress to take action this year. Many people thought the House repeal bill was dead after Speaker Paul D. Ryan pulled it from the floor on March 24, but a slightly revised version was narrowly approved by the House six weeks later.


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Senator John Thune of South Dakota, a member of the Republican leadership, suggested that leaders would press forward with the Senate bill. He said that an argument could be made for delaying it “if you thought you were going to get a better policy,” but that that was not the case.

“This is the best we can do to try and satisfy all the different perspectives in our conference,” Mr. Thune said, adding that he did not think the politics would improve by waiting. “It’s time to fish or cut bait.”

The White House discounted the report, saying the budget office had “consistently proven it cannot accurately predict how health care legislation will impact insurance coverage.”

The Trump administration says the Senate Republican bill would not cut Medicaid because spending would still grow from year to year. But the Congressional Budget Office said that the bill would reduce projected Medicaid spending by a total of $772 billion in the coming decade, and that the number of people covered by Medicaid in 2026 would be 15 million lower than under current law.

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In 2026, it said, Medicaid spending would be 26 percent lower than under current law, and enrollment of people under 65 would be 16 percent lower. Beyond 2026, Medicaid enrollment would keep declining compared with what would happen under current law.

The Senate bill would make it much easier for states to obtain waivers exempting them from certain federal insurance standards, like those that require insurers to provide a minimum set of health benefits. The budget office said that nearly half of all Americans could be affected by these cutbacks in “essential benefits,” and that as a result, coverage for maternity care, mental health care, rehabilitation services and certain very expensive drugs “could be at risk.”

Before the budget office released its report, the American Medical Association had announced its opposition to the bill, and the National Governors Association had cautioned the Senate against moving too quickly.

The budget office’s findings immediately gave fodder to Democrats, who were already assailing the bill as cruel. Senator Chuck Schumer of New York, the Democratic leader, said Senate Republicans had been saying for weeks that their bill would be an improvement over the House bill, which President Trump had described as “mean.”


The C.B.O. Did the Math. These Are the Key Takeaways From the Senate Health Care Bill.

A look at four big numbers in the C.B.O. report.

The budget office had found that under the House bill, the number of people without health insurance would increase by 23 million by 2026 — only slightly more than the 22 million projected for the Senate bill.


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“C.B.O.’s report today makes clear that this bill is every bit as mean as the House bill,” Mr. Schumer said. “This C.B.O. report should be the end of the road for Trumpcare. Republicans would be wise to read it like a giant stop sign, urging them to turn back from this path that would be disastrous for the country, for middle-class Americans and for their party.”

The criticism was not confined to the Democratic caucus. Mr. Johnson, one of five Senate Republicans who said last week that they could not support the bill as drafted, told a radio host that Senate leaders were “trying to jam this thing through.” He, too, suggested he would not vote even to begin debating the bill.

“I have a hard time believing I’ll have enough information for me to support a motion to proceed this week,” Mr. Johnson said later on Monday.

Beyond the number of Americans without insurance, the Senate bill’s $321 billion in deficit reduction is larger than the $119 billion that the budget office found for the bill that passed the House.

Earlier Monday afternoon, Senate Republican leaders altered their bill to penalize people who go without health insurance by requiring them to wait six months before their coverage would begin. Insurers would generally be required to impose the waiting period on people who lacked coverage for more than about two months in the previous year.

The waiting period was meant to address a notable omission in the Senate’s bill: The measure would end the Affordable Care Act’s mandate that most Americans have health insurance, but also require insurers to accept anyone who applied. The proposal is supposed to prevent people from waiting until they get sick to buy a health plan. Insurers need large numbers of healthy people, whose premiums help defray the cost of care for those who are sick.

Under one of the most unpopular provisions of the Affordable Care Act, the government can impose tax penalties on people who go without health coverage. Republicans have denounced this as government coercion.

The repeal bill passed by the House last month has a different kind of incentive. It would impose a 30 percent surcharge on premiums for people who have gone without insurance.

Mr. Trump wrote on Twitter on Monday that Republican senators were “working very hard to get there” but were not getting any help from Democrats.


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“Not easy! Perhaps just let OCare crash burn!” Mr. Trump wrote, reiterating his assertion that the Affordable Care Act would be doomed if Congress did not come to its rescue.

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Hate the Individual Health Mandate? The GOP Tries a ‘Lockout’

Insurers, however, seem warm to the idea. Wellmark, a large plan, has publicly endorsed such a lockout period.


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The Affordable Care Act, of course, tried to nudge uninsured people into the insurance market by charging them a tax penalty if they remained uninsured. But that policy, known as the individual mandate, is loathed by Republicans — and by a segment of the public — and would be eliminated under the Republican bill. The lockout provision in the new bill is an effort to replace it with another form of encouragement.

Some Democratic activists have called the idea punitive to patients with serious illnesses. If you have cancer, they argue, six months of waiting means six months when your disease is not being treated. But the idea is actually fairly similar to one that exists as part of Obamacare.

Under current law, if you let your insurance coverage lapse, you must wait until the next year before you can sign up again. The thinking is that if people could sign up for coverage at any time, they might just wait until they were in an ambulance to call the insurance company. Experts across the political spectrum worry that a world where people can buy insurance whenever they want is a recipe for a so-called death spiral, in which the insurance pool becomes sicker and sicker, and prices rise to unsustainable levels.


How Senate Republicans Plan to Dismantle Obamacare

A comparison of the Senate health care with the Affordable Care Act.

Would a six-month lockout prevent this? Maybe a little. Gail Wilensky, a senior fellow at Project HOPE and a former Bush administration official, who thought the lockout might help, notes that Medicare has some strong penalties for people who sign up late.

But people entering Medicare have plenty of warning, and tend to know they will stay in the program, and eventually get sick. In contrast, most people in the individual insurance market cycle in and out quickly. They may not know all the rules, or even worry about getting coverage, since many assume they’ll be back in an employer plan soon.

“There’s a ton of people churning through,” said John Graves, an assistant professor of health policy at Vanderbilt.

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He has studied the young, healthy uninsured population, and found that it is composed largely of people with short gaps in coverage between jobs. He worried that making sign-ups harder for such people, who already tend to eschew insurance, might discourage them from ever enrolling.

“You’re just kind of putting up these obstacles to all these people who are really the types of people that an insurance company wants,” he said. Mr. Graves said that such a penalty might act as a stronger incentive to people with known health problems, who would be careful to keep their paperwork in order and avoid any lapse in coverage.

On Monday, the Congressional Budget Office, in its assessment of the bill, largely agreed with the experts. Although the C.B.O. said the provision might slightly increase the number of Americans with coverage, that increase was too small for it to even calculate.

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Sens. Johnson, Sanders: No Way Vote Should Happen on Health Care Bill This Week

WASHINGTON — As Congress wrangles over implementing a new health care law, Republican and Democratic senators have not agreed on much, but there was one area where two lawmakers on opposite sides of the aisle found common ground on the issue on Sunday.

Both Sen. Ron Johnson, R-Wis., and Sen. Bernie Sanders, I-Vt., who each have expressed serious reservations with the bill for very different reasons, proclaimed during exclusive interviews on Sunday’s “Meet The Press” that rushing a vote before the July 4th recess would be unwise.

“There’s no way we should be voting on this next week. No way,” Johnson told host Chuck Todd. “I have a hard time believing Wisconsin constituents or even myself will have enough time to properly evaluate this, for me to vote for a motion to proceed. So I’ve been encouraging leadership, the White House, anybody I can talk to for quite some time, let’s not rush this process. Let’s have the integrity to show the American people what it is, show them the truth.”

Republican senators unveiled their version of the health bill on Thursday, and Majority Leader Mitch McConnell has indicated he wants to see a vote before the end of this week.

The Senate bill includes big cuts to Medicaid over a period of time, eliminates taxes on the wealthy and insurers, and does not let insurers deny people coverage based on pre-existing conditions. Unlike the House bill, it pegs tax credits to income rather than age.

Johnson is one of four conservative Republican senators — along with Sens. Ted Cruz, Mike Lee, and Rand Paul — who released a statement Thursday saying that they are not yet ready to vote for the bill, but that they are “open to negotiation.”

“What I find so disappointing is these bills aren’t going to fix the problem,” Johnson said Sunday. “They’re not addressing the root cause. They’re doing the same old Washington thing, throwing more money at the problem.”

Republican Sen. Dean Heller of Nevada also said he doesn’t support the bill, but because of its cuts to Medicaid and his worries that it will not lower insurance premiums for people.

Sen. Sanders meanwhile is currently on a tour across multiple states to rally opposition to the bill.

The former presidential candidate doubled down on his claims from last week that “thousands of people will die” if the Senate bill passes, a line that drew ire from the office Republican Sen. Orrin Hatch.

“The brief time when we were *not* accusing those we disagree with of murder was nice while it lasted,” Hatch’s staff wrote on Twitter on Friday

But Sanders reiterated on Sunday’s “Meet The Press”: “If you have cancer and your insurance is taken away from you, there is a likelihood you will die and certainly a likelihood you will become much sicker.”

Sanders added: “Senator Johnson is right. There is no way on God’s Earth that this bill should be passed this week. The people of Wisconsin don’t know what’s in it, the people of Vermont don’t know what’s in it. We need a serious discussion.”

He did, however, acknowledge that there are problems with the current health care system that need to be addressed.

“My view is, that the Affordable Care Act has problems,” he said. “Deductibles are too high. Copayments are too high. We have to address that.”

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The Senate’s three big lies about health care

To succeed in gutting health coverage for millions of Americans, Senate Republican leaders need to get a series of lies accepted as truth. Journalists and other neutral arbiters must resist the temptation to report these lies as just a point of view. A lie is a lie.

Lie One: Democrats and progressives are unwilling to work with Republicans and conservatives on this issue. “If we went and got the single greatest health-care plan in the history of the world, we would not get one Democrat vote,” President Trump told an Iowa crowd last Wednesday.

In fact, Democrats, including President Barack Obama when he was in office, have said repeatedly that they would like to work with Republicans to improve the Affordable Care Act. Senate Democratic leader Charles E. Schumer’s office put out a list of such offers, including a June 15 letter from Schumer to Senate Majority Leader Mitch McConnell calling for a cross-party meeting to “find a way to make health care more affordable and accessible.”

But Democrats can never be complicit in a wholesale repeal of Obamacare that would take health coverage away from millions of Americans.

This first lie is important because it rationalizes the Republican claim that the bill has to be draconian because it can’t pass without support from the party’s most right-wing legislators. “This is not the best possible bill,” said Sen. Pat Roberts (R-Kan.). “It is the best bill possible under very difficult circumstances.”

But those “circumstances” have been created by the GOP itself. A completely different coalition is available, but Republicans don’t want to activate it because they are hellbent on repealing Obamacare. Why?

This brings us to Lie Two: This bill is primarily about improving health care for American families. No, this effort is primarily about cutting taxes. When it comes to health care, the main thing the bill does is take money away from providing it to pay for the tax reductions it contains and for future bonanzas the Republicans have promised.

The tax cuts in this legislation alone would amount to some $700 billion over a decade, according to the Center on Budget and Policy Priorities. About $33 billion of this would go to tax cuts conservatively averaging $7 million every year to each of the 400 highest-income families in the country. What could $33 billion buy? The CBPP reports it would be enough to pay for the expansion of Medicaid in Nevada, West Virginia, Arkansas and Alaska. Talk about income redistribution.

A telltale: One of the main Republican complaints about Obamacare has been that the deductibles and co-pays under ACA policies are too high. But the Republican bill only makes this problem worse.

As the New York Times’ Margot Sanger-Katz wrote: “Many middle-income Americans would be expected to pay a larger share of their income to purchase health insurance that covers a smaller share of their care.”

If this bill were truly about health care, Republicans would take all the tax cuts out and use that money to ease the pain their bill would cause. But they won’t, because the tax cuts are the thing that matters to them.

Lie Three: The Senate bill is a “compromise.” Really? Between whom? The House wants to destroy Obamacare quickly, the Senate a bit more slowly while also cutting Medicaid more steeply over time. This is only a “compromise” between two very right-wing policies.

Imagine you are negotiating with two creditors who say you owe them $1,000 and you insist you owe nothing. The first creditor wants the money quickly. The second says you can take a bit little longer, but you have to pay $1,200 — and he has the nerve to call this a “compromise.” Nowhere in this deal is your position taken into account. Welcome to the logic of the Senate health-care bill.

I hope I never have to write about Lie Four, which would be Republican senators who surely know better — including Susan Collins, Dean Heller, Lisa Murkowski, Jeff Flake, Shelley Moore Capito and Rob Portman — justifying their votes for this monstrosity by claiming that it’s the best they could do.

Heller signaled doubts about the proposal on Friday, which is a step in the right direction. But only by killing this bill would these senators open the way for reasonable fixes to the ACA. Do they really want to say someday that one of their most important votes in the Senate involved taking health care away from millions of Americans? I would like to believe they are too decent for that. I hope I’m not lying to myself.

Read more from E.J. Dionne’s archive, follow him on Twitter or subscribe to his updates on Facebook.

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The Post’s View: Republicans’ health-care hypocrisy is on full display

The Post’s View: Betrayal, carelessness, hypocrisy: The GOP health-care bill has it all

Avik Roy: The Senate’s health-care bill could be one of the GOP’s greatest accomplishments

Henry Olsen: Here’s how Ronald Reagan would fix the GOP’s health-care mess

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Trump: Not ‘that far off’ from passing health overhaul

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Making a final push, President Donald Trump said he doesn’t think congressional Republicans are “that far off” on a health overhaul to replace “the dead carcass of Obamacare.”

Expressing frustration, he complained about “the level of hostility” in government and wondered why both parties can’t work together on the Senate bill as GOP critics expressed doubt over a successful vote this week.

Donald Trump speaking from the White House on June 20, 2017.

It was the latest signs of high-stakes maneuvering over a key campaign promise, and the president signaled a willingness to deal.

“We have a very good plan,” Trump said in an interview broadcast Sunday. Referring to Republican senators opposed to the bill, he added: “They want to get some points, I think they’ll get some points.”

Trump’s comments come amid the public opposition of five Republican senators so far to the Senate GOP plan that would scuttle much of former President Barack Obama’s health law.

Unless those holdouts can be swayed, their numbers are more than enough to torpedo the measure developed in private by Senate Majority Leader Mitch McConnell, R-Ky., and deliver a bitter defeat for the president. That’s because unanimous opposition is expected from Democrats in a chamber in which Republicans hold a narrow 52-48 majority.

Trump bemoaned the lack of bipartisanship in Washington, having belittled prominent Democrats himself.

“It would be so great if the Democrats and Republicans could get together, wrap their arms around it and come up with something that everybody’s happy with,” the president said. “And I’m open arms; but, I don’t see that happening. They fight each other. The level of hostility.”

Trump has denigrated Democrats on numerous occasions, including a jab at Democratic Sen. Elizabeth Warren in the same interview: “She’s a hopeless case. I call her Pocahontas and that’s an insult to Pocahontas.”

Warren, a leading liberal and defender of the Affordable Care Act, has opposed efforts to pass a bill to replace the law. The Democrat reiterated her opposition in a statement to The Associated Press on Sunday, saying the health care bill being pushed by Senate Republicans is a “monstrosity.”

In a tweet last week after Georgia’s special House election, Trump also criticized House Democratic Leader Nancy Pelosi and Senate Democratic Leader Chuck Schumer. “I certainly hope the Democrats do not force Nancy P out. That would be very bad for the Republican Party — and please let Cryin’ Chuck stay!” he wrote.

Demonstrators hold signs during a healthcare rally opposing the American Health Care Act (AHCA) bill on Capitol Hill in Washington, D.C., U.S., on Wednesday, June 21, 2017.

In the broadcast interview, Trump did not indicate what types of changes to the Senate bill may be in store, but affirmed that he had described a House-passed bill as “mean.”

“I want to see a bill with heart,” he said, confirming a switch from his laudatory statements about the House bill at a Rose Garden ceremony with House GOP leaders last month. “Healthcare’s a very complicated subject from the standpoint that you move it this way, and this group doesn’t like it.”

“And honestly, nobody can be totally happy,” Trump said.

McConnell has said he’s willing to make changes to win support, and in the week ahead, plenty of backroom bargaining is expected. He is seeking to push a final package through the Senate before the July 4 recess.

At least two GOP senators said Sunday that goal may prove too ambitious.

“I would like to delay,” said Sen. Ron Johnson, R-Wis., one of the five senators opposing the bill. “These bills aren’t going to fix the problem. They’re not addressing the root cause,” he said, referring to rising health care costs. “They’re doing the same old Washington thing, throwing more money at the problem.”

Sen. Susan Collins, R-Maine, said seven to eight other senators including herself were troubled by provisions that she believes could cut Medicaid even more than the House version.

Collins, who also opposes proposed cuts to Planned Parenthood, said she would await an analysis Monday from the nonpartisan Congressional Budget Office before taking a final position on the bill. But she said it will be “extremely difficult” for the White House to be able to find a narrow path to attract both conservatives and moderates.

“It’s hard for me to see the bill passing this week,” Collins said.

Addressing reporters Sunday, the Senate’s No. 2 Republican said passing a health care bill won’t get any easier if Republican leaders delay a Senate vote on the GOP health care plan. Sen. John Cornyn of Texas said there is “a sense of urgency” to push forward but acknowledged the outcome is “going to be close.”

Trump's core voters could suffer most under GOP health bill, but they may not punish him for it

He told reporters at a private gathering hosted by the libertarian Koch brothers in Colorado that Trump will be “important” in securing the final votes.

“We’re trying to hold him back a little bit,” Cornyn said with a smile.

The Senate bill resembles legislation the House approved last month. A Congressional Budget Office analysis of the House measure predicts an additional 23 million people over the next decade would have no health care coverage, and recent polling shows only around 1 in 4 Americans views the House bill favorably.

The legislation would phase out extra federal money that more than 30 states receive for expanding Medicaid to additional low-income earners. It would also slap annual spending caps on the overall Medicaid program, which since its inception in 1965 has provided states with unlimited money to cover eligible costs.

Conservative Sen. Rand Paul, R-Ky., said he is opposing the Senate bill because it “is not anywhere close to repeal” of the Affordable Care Act. He says the bill offers too many tax credits that help poorer people to buy insurance.

“If we get to impasse, if we go to a bill that is more repeal and less big government programs, yes, I’ll consider partial repeal,” he said. “I’m not voting for something that looks just like Obamacare.”

Trump said he thinks Republicans in the Senate are doing the best they can to push through the bill.

“I don’t think they’re that far off. Famous last words, right? But I think they’re going to get there,” Trump said of Republican Senate leaders. “We don’t have too much of a choice, because the alternative is the dead carcass of Obamacare.”

Schumer said Democrats have been clear they will cooperate with Republicans if they agree to drop a repeal of the Affordable Care Act and instead work to improve it. Still, Schumer acknowledged it was too close to call as to whether Republicans could muster enough support on their own to pass the bill.

He said they had “at best, a 50-50 chance.”


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Koch chief says health care bill insufficiently conservative – ABC News

Chief lieutenants in the Koch brothers’ political network lashed out at the Senate Republican health care bill on Saturday as not conservative enough, becoming a powerful outside critic as GOP leaders try to rally support for their plan among rank-and-file Republicans.

Tim Phillips, who leads Americans For Prosperity, the Koch network’s political arm, called the Senate’s plans for Medicaid “a slight nip and tuck” of President Barack Obama’s health care law, a modest change he described as “immoral.”

“This Senate bill needs to get better,” Phillips said. “It has to get better.”

Some Republican senators have raised concern about cuts to Medicaid, which provides health care coverage to millions of poor and middle-income Americans. Several more conservative senators have voiced opposition because they feel it does not go far enough in dismantling what they call “Obamacare.”

The comments came on the first day of a three-day private donor retreat at a luxury resort in the Rocky Mountains. Invitations were extended only to donors who promise to give at least $100,000 each year to the various groups backed by the Koch brothers’ Freedom Partners — a network of education, policy and political entities that aim to promote small government.

“When I look at where we are at the size and effectiveness of this network, I’m blown away,” billionaire industrialist Charles Koch told hundreds of donors during an outdoor evening reception. His brother, David Koch, looked on from the crowd along with Sens. Mike Lee of Utah and Jeff Flake of Arizona.

“We’ve got to keep doing it at an accelerated pace,” Charles Koch said.

No outside group has been move aggressive over the yearslong push to repeal Obama’s health care law than the Kochs’, who vowed on Saturday to spend another 10 years fighting to change the health care system if necessary. The Koch network has often displayed a willingness to take on Republicans — including President Donald Trump — when their policies aren’t deemed conservative enough.

Network spokesman James Davis said the organization would continue to push for changes to the Senate health care bill over the coming week.

“At the end of the day, this bill is not going to fix health care,” Davis declared.

The network’s wishes are backed by a massive political budget that will be used to take on Republican lawmakers, if necessary, Phillips said.

He described the organization’s budget for policy and politics heading into the 2018 midterm elections as between $300 million and $400 million. “We believe we’re headed to the high end of that range,” he said.

On Friday, Nevada Republican Dean Heller became the fifth GOP senator to declare his opposition to the Senate health care proposal. Echoing the other four, Heller said he opposes the measure “in this form” but does not rule out backing a version that is changed to his liking.

Heller, facing a competitive re-election battle next year, said he was opposing the legislation because of the cuts it would make in Medicaid.

Senate Majority Leader Mitch McConnell, R-Ky., has said he’s willing to alter the measure to attract support, and promised plenty of back-room bargaining as he tries pushing a final package through his chamber next week.

Republican leaders have scant margin for error. Facing unanimous Democratic opposition, McConnell can afford to lose just two of the 52 GOP senators and still prevail.

At least two of the current opponents, Lee and Texas Sen. Ted Cruz, were among 18 elected officials scheduled to attend the Koch retreat. Two more undecideds were also on the guest list: Flake and Nebraska Sen. Ben Sasse.

President Donald Trump continued to push for replacing Obama’s health care law, tweeting Saturday: “I cannot imagine that these very fine Republican Senators would allow the American people to suffer a broken ObamaCare any longer!”

The Senate measure resembles legislation the House approved last month that the nonpartisan Congressional Budget Office said would mean 23 million additional uninsured people within a decade and that recent polling shows is viewed favorably by only around 1 in 4 Americans.

Charles Koch and his chief lieutenants met privately with Vice President Mike Pence for nearly an hour Friday. Pence, a longtime Koch ally, was in Colorado Springs to address a gathering of religious conservatives.

Phillips said it was “a cordial discussion” about policy, but that neither side asked the other for anything specific.

Also Saturday, retired football star Deion Sanders announced plans to partner with the Kochs to help fight poverty in Dallas.

The unlikely partnership aims to raise $21 million over the next three years to fund anti-poverty programs in the city where Sanders once played football. The outspoken athlete also defended Koch, who is often demonized by Democrats, as someone simply “trying to make the world a better place.”

“I’m happy where I am and who I’m with because we share a lot of the same values and goals,” Sanders said when asked if he’d be willing to partner with organizations on the left.

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Bernie Sanders headlining ‘don’t take our health care’ rallies in three states

Sen. Bernie Sanders is headlining a “don’t take our health care” rally tonight in Pittsburgh as a first stop on a three-state tour to mobilize opposition to the Senate health care bill, which the Vermont senator has called “by far the most harmful piece of legislation I have seen in my lifetime.”

Sanders teamed up with progressive advocacy organization to hold rallies this weekend in Pittsburgh; Columbus, Ohio; and Charleston, West Virginia, with the goal of pressuring Republican senators in each of the states to oppose the legislation released Thursday.

Republican Sens. Pat Toomey in Pennsylvania, Rob Portman in Ohio and Shelley Moore Capito in West Virginia have said they’re reviewing the legislation and have not made a final decision.

Toomey issued the most supportive statement of the three, calling the Senate bill, “an important and constructive first step in repealing Obamacare and replacing it.”

Five GOP senators have so far announced their opposition to the bill drafted by some of their Republican colleagues. Republicans can afford only two defections from the 52 senators in their ranks to pass the bill.

The nonpartisan Congressional Budget Office is expected to release its assessment of the bill early next week.

Sanders has slammed the legislation as “disastrous,” saying in a statement Thursday that it “has nothing to do with health care. It has everything to do with an enormous transfer of wealth from working people to the richest Americans.”

Sanders spokesperson Josh Miller-Lewis told ABC News, “We’re at a pivotal moment in the fight to save health care and the goal this weekend is to elevate that fight.”

All three of the states where the senator and MoveOn are holding rallies were won by President Trump in the 2016 election.

The first rally is tonight at 7 p.m. in Pittsburgh, followed by events Sunday in Ohio and West Virginia.

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Senate health-care bill faces serious resistance from GOP moderates

A small group of moderate Republican senators, worried that their leaders’ health-care bill could damage the nation’s social safety net, may pose at least as significant an obstacle to the measure’s passage as their colleagues on the right.

The vast changes the legislation would make to Medicaid, the country’s broadest source of public health insurance, would represent the largest single step the government has ever taken toward conservatives’ long-held goal of reining in federal spending on health-care entitlement programs in favor of a free-market system.

That dramatic shift and the bill’s bold redistribution of wealth — the billions of dollars taken from coverage for the poor would help fund tax cuts for the wealthy — is creating substantial anxiety for several Republican moderates whose states have especially benefited from the expansion of Medicaid that the Affordable Care Act has allowed since 2014.

Their concerns that the legislation would harm the nation’s most vulnerable and cause many Americans to become uninsured have thrust into stark relief the ideological fault lines within the GOP. Though Senate conservatives were the first to threaten to torpedo the bill, contending that it is too generous, the potential loss of nearly half a dozen moderate lawmakers’ votes may be the main hurdle. Since the bill will get no support from Democrats, Senate Majority Leader Mitch McConnell can afford defections from no more than two Republicans as he tries to bring it to a vote this week.

His odds worsened Friday when Sen. Dean Heller (R-Nev.), who is up for reelection next year, said he could not support the bill in its current form. Heller specifically cited its cuts to Medicaid, not just by ending its expansion in Nevada and 30 other states but by restricting government spending for the program starting in 2025.

This bill “is simply not the answer,” he declared, describing some of the 200,000 Nevadans who have gained health coverage through the expansion. He rhetorically asked whether the Republican plan will ensure that they have insurance in the future. “I’m telling you, right now it doesn’t do that,” he said.

Though three of the other four wavering GOP centrists also come from Medicaid-expansion states, not all were as explicit as Heller in their reactions after the Better Care Reconciliation Act was finally unveiled late last week. Both Sens. Shelley Moore Capito (W.Va.) and Lisa Murkowski (Alaska) said that they would evaluate it with an eye toward its effect on low-income residents.

“It needs to be done right,” Murkowski said in a tweet. “I remain committed to ensuring that all Alaskans have access to affordable, quality health care.”

Part of the pressure the moderates now face is that Medicaid consistently draws widespread support in surveys. A poll released Friday by the Kaiser Family Foundation found that three-fourths of the public, including 6 in 10 Republicans, said they have a positive view of the program. Just a third of those polled said they supported the idea of reducing federal funding for the expansion or limiting how much money a state receives for all beneficiaries.

Even among Republicans, the foundation found, only about half favor reversing the federal money for Medicaid expansion.

Congressional budget analysts plan to issue their projections as early as Monday on the legislation’s impact on the federal deficit and the number of Americans with insurance coverage. Already, proponents and critics alike are predicting that the Senate proposal would lead to greater reductions through the Medicaid changes than the estimated $834 billion estimated for a similar bill passed by House Republicans last month.

“The focus of Republican efforts largely has been on costs,” said Lanhee Chen, a research fellow at Stanford University’s Hoover Institution. “You do have a different set of issues that the two sides have been focused on, which partly explains why this has been such an intractable and difficult debate to find common ground on.”

See where the Senate health-care bill’s subsidy cuts will affect Americans most View Graphic See where the Senate health-care bill’s subsidy cuts will affect Americans most

Under the Senate GOP version, 2021 is when Medicaid’s transformation would begin. The expansion, which has provided coverage to roughly 11 million people, would be phased out. What is now an open-ended entitlement, with federal funding available for a specific share of whatever each state spends, would be converted to per capita payments or block grants.

Then, four years later, the federal government would apply an inflation factor to spending increases that would be equal to the urban consumer price index rather than the higher medical inflation rate used in the House bill.

“There has never been a rollback of basic services to Americans like this ever in U.S. history,” said Bruce Siegel, president of America’s Essential Hospitals, a coalition of about 300 hospitals that treat a large share of low-income patients. “Let’s not mince words. This bill will close hospitals. It will hammer rural hospitals, it will close nursing homes. It will lead to disabled children not getting services. . . . People will die.”

To some extent, the division within the GOP’s ranks reflects geography. Some of the most reticent senators come from states where health-care systems stand to lose the most financially if the bill passed.

According to an analysis by the Commonwealth Fund, hospitals in Nevada would be saddled over the next decade with at least double the costs in “uncompensated care” — bills for which neither an insurer nor a patient paid. It examined the House legislation but noted that the Senate bill would doubtless hit harder because of its deeper reductions in federal Medicaid payments.

Hospitals in West Virginia would suffer an even greater spike in uncompensated care, about 122 percent during the decade. But the analysis showed that the greatest damage would come in McConnell’s own state: Kentucky, which has had the nation’s largest Medicaid expansion under the ACA, would see a 165 percent jump in unpaid hospital bills.

Yet conservative Sen. Patrick J. Toomey (R-Pa.), one of the bill’s champions, said it would establish “a very, very gradual and gentle transition to a normal inflation rate” for a program in which he said costs were spiraling out of control. Beyond Medicaid, it would permit private health plans to cover fewer services and would allow individuals and employers to eschew coverage without penalty — elements that its authors say could lower how much consumers pay for their insurance.

“The idea that there’s a sector of our economy that has to permanently have a higher inflation rate than the rest of our economy is ridiculous,” Toomey said Thursday. “I think that it’s absolutely essential to putting [Medicaid] on a sustainable path so that it will be there for future generations.”

Avik Roy, a conservative health expert who serves as president of the Foundation for Research on Equal Opportunity, said the legislation’s proponents need to show “that competitive insurance markets can work for the poor and the vulnerable and the sick.”

People too often equate federal spending with establishing a safety net, when greater competition and a free market could produce better results at a lower cost, in Roy’s view. The Senate bill would extend “quite robust” tax credits to many people, he said, even to those living in poverty who were not eligible for Medicaid: “Republicans have a different view of what a safety net should look like.”

Pressure is coming from outside groups on the right. Though the four conservatives who have voiced opposition to the bill might be pushed hard — Sens. Rand Paul (Ky.), Mike Lee (Utah), Ted Cruz (Tex.) and Ron Johnson (Wis.) — Heller will be a special target. A super PAC, America First Policies, reportedly is planning a seven-figure ad buy just in Nevada.

But patient-advocacy organizations that focus on an array of diseases are intensifying their own lobbying on the bill, including running print and online ads in several key states. If one health issue has emerged as a flash point, however, it is the nation’s opioid epidemic.

Shatterproof, a national nonprofit organization focused on addressing addiction, estimates that 2.8 million people have gained access to substance-abuse treatment under Medicaid expansion. In Ohio alone, total federal funding provided 70 percent of the $939 million that the state spent to combat the epidemic last year.

Capito and Sen. Rob Portman (Ohio) have asked the chamber’s Republican leaders to provide in the bill $45 billion over 10 years to address opioids; the measure currently provides $2 billion. But that amount, Shatterproof chief executive Gary Mendell said Friday, is less than a tenth of what experts predict will be needed over the next decade. And providing a designated fund while leaving millions uninsured makes little sense, he added.

Shatterproof just launched a six-figure advertising buy in Ohio, West Virginia and Maine — which is represented by another undecided Republican, Sen. Susan Collins — to urge the states’ senators to vote against the bill. Mendell noted that Portman has been a champion on substance-use treatment for years, and it was difficult to run ads targeting him.

“His people need to understand that this has to be a no vote,” Mendell said.

Specific constituencies aside, some policy experts regard the Senate’s plan as a wholesale reversal of the government’s path to offer health insurance to ever-wider groups of Americans, piece by piece. That started with the creation of Medicaid and Medicare as part of President Lyndon B. Johnson’s Great Society and could be ending with the ACA.

“This is bringing us back to where we were before 1965,” said Paul Starr, a Princeton University professor of sociology and public affairs who has written extensively about the history of U.S. health-care policy. “There is no longer the federal commitment to back up the states in terms of health care for the poor.”

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How the GOP health care bills help the rich

The Senate GOP health care bill explained

If Republican efforts to repeal and replace Obamacare are successful, one of the biggest winners would be the wealthy.

The Senate’s bill — released this week — differs in key ways from the House-passed version. But proposals eliminate the taxes imposed on high-income Americans to help pay for an expansion of health benefits under the Affordable Care Act. The legislation also would let people contribute more to certain tax-advantaged accounts.

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At the same time, both bills are expected to disproportionately hurt lower income households by reducing funding for Medicaid and offering less generous subsidies to buy health insurance.

Here are the key provisions under the Senate and House health bills that would benefit the highest-income households.

Eliminate Medicare surtax on wages

High-income earners currently pay the 1.45% Medicare payroll tax on wages up to $200,000 ($250,000 if married). But then they pay an additional 0.9 percentage points — or 2.35% — on wages above those levels.

Under both the Senate and House bills, that surcharge goes away in 2023.

Get rid of Medicare tax on investments

In addition to the surtax on wages, high-income earners making more than $200,000 ($250,000 if married filing jointly) are subject to a 3.8% Medicare tax on a portion of their investment income, which is determined by formula. Investment income includes money from capital gains, dividends, interest, rental income and annuities.

Related: Who gets hurt and who gets helped by the Senate health care bill

The Senate and House bills would eliminate this so-called net investment income tax and make the repeal retroactive to Jan. 1, 2017. In other words, if you sell — or have already sold — any stocks this year that have big long-term gains, you would not be subject to the surtax when you fill out your 2017 federal tax return next spring. You would pay a 20% tax rate on all of your gains instead of 23.8% on some of them.

Effectively, making it retroactive simply rewards people who happened to have sold their stock already.

“You’re not affecting behavior at all. It’s just a tax cut for high-income people,” said Mark Mazur, director of the Tax Policy Center.

Related: What’s inside the Senate Republican health care bill

Make tax-advantaged accounts for health costs more generous

Today, individuals can save up to $3,400 and families can save up to $6,750 tax free in a Health Savings Account. The Senate and House bills would raise that limit to the annual out-of-pocket maximum for high-deductible plans. For 2018, that would be $6,650 for individuals and $13,300 for families.

The legislation also would eliminate the caps on contributions to tax-deductible flexible spending accounts. Right now, employed individuals may each save up to $2,600 a year, so a two-earner couple can put away $5,200.

Raising or eliminating contribution limits on tax-advantaged accounts disproportionately benefits the highest-income Americans because they’re in the best position to sock away more money.

The bills would also end the Obamacare prohibition on paying for over-the-counter medications with funds from tax-advantaged health accounts. And they reduce the penalty from 20% to 10% — which was the pre-Obamacare levy — if funds from an HSA are used for non-medical purposes. These provisions would take effect in 2018.

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