Gov. Scott Walker is going to bat for a last-ditch Republican plan to remake the American health care system that would give him and other governors far more say over how health coverage works in their states.
U.S. Sen. Ron Johnson, R-Oshkosh, is one of four GOP senators offering the plan, which revived GOP efforts to roll back President Barack Obama’s health care law, also known as Obamacare, although prospects for passage now appear slim.
In a matter of days, the plan went from obscurity to being set for a U.S. Senate vote in coming days. But just as quickly, those plans were thrown into doubt late Friday by news that the potentially decisive vote, Sen. John McCain of Arizona, will oppose the measure.
Sen. Tammy Baldwin, D-Madison, says the plan would take away health coverage for hundreds of thousands of Wisconsinites. She said many others could lose key protections such as not being charged more based on an illness.
The GOP plan would overhaul Medicaid, end the individual mandate requiring everyone to have health insurance or pay a penalty, and convert the Obamacare individual marketplace into a program by which states would get federal grants to craft their own health care initiatives.
Johnson wouldn’t say, when pressed in an MSNBC interview Thursday, if Americans would lose coverage under his plan.
An analysis released Friday by the nonpartisan Brookings Institution found 21 million fewer Americans would have coverage under the plan, while adding the figure “likely understates the reductions in insurance coverage that would actually occur.”
The typical shared source for such information, the Congressional Budget Office, has yet to offer a full analysis of the plan’s impacts. In an unusual move, Senate Republicans are poised to vote before receiving that analysis, known as a CBO score.
“If we don’t have a CBO score, no one can credibly say they know what’s in the bill before we pass it,” U.S. Rep. Mark Pocan, D-Black Earth, said last week.
Noel Deep, president of the Wisconsin Medical Society, said in a statement: “There are still far too many unanswered questions about the current proposal’s short- and long-term effects on health care coverage in Wisconsin.”
Walker has endorsed the plan, calling it “awesome” in a recent Breitbart News interview. In addition to Johnson, its three other sponsors are Sens. Bill Cassidy of Louisiana, Lindsey Graham of South Carolina and Dean Heller of Nevada.
President Donald Trump also is backing the plan, the case for which, Johnson and other supporters say, is simple: it is Republicans’ last chance to repeal Obamacare.
“This is the alternative,” Johnson, R-Oshkosh, said last week. “Anybody who doesn’t think this is good enough, understand if we don’t do this, it is Obamacare — and that is codified forever.”
Funding boost for state
Baldwin said constituents are telling her they’re surprised at the plan’s sudden emergence.
“What I’m hearing from Wisconsinites on #GrahamCassidy is pretty clear: We thought we were done with heartless, partisan repeal plans,” Baldwin tweeted Wednesday.
Baldwin recently staked her support to a diametrically opposite health care proposal: Sen. Bernie Sanders’ “Medicare-for-all” single-payer plan.
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Meanwhile, Johnson has mounted a national media blitz during the last week on behalf of a fast-track vote on his bill.
Senate procedural rules say Republicans only have until Saturday to pass a health care overhaul with a simple majority vote. That’s the only realistic path for Republicans, who control 52 of 100 seats in the chamber, to pass such a bill with no Democratic votes.
If it were to pass the Senate, the bill would head to the U.S. House, which passed a different Obamacare repeal bill in May.
The plan would create a framework through which the 50 states would get block grants to design health coverage initiatives for people currently covered on Obamacare exchanges and under the law’s Medicaid expansion.
Beneficiaries of this change would include Wisconsin and other states that rejected Medicaid expansion. Wisconsin would see an infusion of about $3.5 billion in federal money during the next six years under the bill, according to an independent analysis by the nonpartisan Kaiser Family Foundation.
Block grant funding beyond 2026 is not provided in the plan, making its future uncertain after that point.
The plan also would overhaul Medicaid from a program that doles out federal money to states on a matching basis, relative to how much they spend, to a per-capita model.
That change would cut federal funding for Medicaid compared to the course set under current law. Wisconsin would get $562 million fewer federal dollars for Medicaid between now and 2026, Kaiser found.
Then there’s the question of how the plan treats people with pre-existing conditions, protections for which are among Obamacare’s most popular provisions.
The law would not eliminate Obamacare’s prohibition on denying coverage to people with pre-existing conditions. But state governments could waive requirements that insurers not charge more for people with pre-existing conditions or that all health plans cover certain essential benefits.
“I don’t know what Scott Walker would do” if given that authority, Pocan said.
In May, Walker said he would consider letting insurers hike premiums for people with pre-existing medical conditions if federal Obamacare laws were changed to permit it. Soon after he tweeted that “It is a given that WI will ensure coverage for people with pre-existing conditions.”
Walker’s office did not respond Friday to a State Journal inquiry about how he would handle the question of whether insurers should be able to charge higher premiums.
The plan’s state-centered approach has the Wisconsin Hospital Association “preparing to pivot our focus from Washington to Wisconsin,” according to its president, Eric Borgerding.
“If this bill becomes law, tremendous authority will devolve back to the states, and determining the path and direction of coverage will rest squarely in Madison,” Borgerding said.