The U.S. Senate leadership is promising a vote before July 4 on its bill to repeal and replace the Affordable Care Act, also known as Obamacare.
The fly in the ointment for the GOP is that not all Republicans consider the bill sufficiently conservative. The task for U.S. Sen. John Cornyn from Texas, the second-ranking senator in the GOP, is to sell his colleagues on the plan he helped draft.
Cornyn says the Better Care Reconciliation Act is a compromise between what moderate and conservative Republicans want in an Obamacare replacement plan. It was drafted behind closed doors by a group of 13 Republicans. Democrats, who oppose repeal and replace efforts, were not consulted.
"Unfortunately, Democrats refused to participate in the process," Cornyn says. "We would love to have this be a bipartisan bill, but they are so bought-in to Obamacare, despite its evident failings, that they simply are unwilling to work with us. And I hope that changes in the future."
The Senate GOP's bill was drafted to the needs of those Cornyn says are being hurt by Obamacare.
"We were left with the 52 Republicans having to work together with our House counterparts to try to come up with something that would, number one, save [millions of] people who are currently being hurt … by high premiums and deductibles and evaporating insurance markets where their choices have been reduced to one, and in some cases none," Cornyn says.
The Senate bill does away with Obamacare's employer and individual insurance mandates, as well as requirements that insurance plans cover specific items, including ER visits, lab tests and care for newborns, among others. But the plan retains the Obamacare requirement to cover individuals with pre-existing conditions, and to allow young people to remain on a parent's insurance plan until age 26. Some conservatives, including Texas Sen. Ted Cruz, have said they will oppose the bill in its present form because it doesn't go far enough toward repeal.
"It's a compromise, which I know to some minds is a dirty word, but we had to get 50 votes in the Senate for this bill," Cornyn says. "So we have a spectrum from moderates in the Republican conference to rock-ribbed conservatives."
Cornyn says the bill must pass.
"To my mind, failure is not an option," he says.
Beyond simply repealing Obamacare, Cornyn says the Senate bill does offer improvements for health care consumers.
"For low-income individuals in places like Texas, where they did not expand Medicaid, we offer a tax credit they can use to buy insurance," Cornyn says. He estimates the tax credit could improve insurance access for as many as 800,000 Texans.
Cornyn says he is working with conservatives who oppose the current bill, including U.S. Sen. Ted Cruz, who Cornyn says "wants to get to yes."
"From what he told me, [Cruz's] concerns are primarily about getting premiums down… and certainly I share that goal," Cornyn says.
In the wake of criticism of the way the Senate bill was crafted, and the Senate leadership's push to schedule a vote this week, Cornyn says the debate on health care policy has been going on for at least seven years.
"We've had multiple hearings and meetings on this, and so I think at some point you have to make a decision," Cornyn says. "What's driving the urgency of this now is the fact that insurance companies are going to be going to the state regulators, telling them how much the rates will be in the Obamacare exchanges in 2018. We've seen a 105 percent increase since 2013, and my concern is that if we don't act promptly, we're going to see another double-digit increase in health care premiums next year."
Written by Shelly Brisbin.