DENVER – U.S. Rep. Mike Coffman, a Colorado Republican, is offering up a three-pronged approach to break up the provisions of the health care and tax-related measures in the GOP versions of the bills aimed at repealing and replacing the Affordable Care Act in order to try and garner more bipartisan support to fix some provisions of the ACA.
Coffman voted against the House version of the bill, the American Health Care Act, when the lower chamber of Congress passed the bill onto the Senate by a narrow vote in early May.
At the time, he pointed to a lack of coverage for people with pre-existing conditions and concerns about Medicaid coverage as reasons for voting against the bill.
But the Senate’s version of the bill made similar cuts to Medicaid, according to scores from the Congressional Budget Office, and the bill couldn’t garner enough favor among Republicans to get a floor vote, despite Republicans having the majority in the Senate.
Senate Majority Leader Mitch McConnell on Tuesday said the Senate would cut the first two weeks off its August recess in order to tackle a handful of issues, including tax reform. But he still wants to unveil a new Senate health care bill this week and wants the full Senate to vote on the bill next week. If that doesn’t happen, senators will also be working on health care in August.
First facet: Medicaid expansion reform through reconciliation
But Coffman offered a solution Tuesday: use reconciliation to address the Medicaid expansion facet of Obamacare and repeal the individual and employer mandates; use reconciliation to reform Obamacare’s tax code, along with other tax reforms that Republicans have said they will work to fix this year; and work with both parties to fix the health care exchanges that people on both sides of the aisle have said are the key problem with Obamacare.
“We need to get something done, and this is a way to do it, and not in a massive bill that goes way beyond the Affordable Care Act,” Coffman told Denver7 in an interview Tuesday night. “That that doesn't make any sense to me.”
“Reconciliation” is the congressional term used for the process by which the Senate can vote to pass a matter with only a simple majority of votes, rather than the usual two-thirds majority. It also forces the Senate to only debate a bill for fewer than 20 hours.
But reconciliation can only be used for tax, spending and debt issues, and can’t apply to any proposed policy changes.
Medicaid funding usually comes half from the state and half from the federal government, as it does in Colorado. The nationwide average is about 57 percent coming from the feds.
But under the Medicaid expansion program Obamacare allowed states to opt into, which Colorado and 30 other states did, states pay a small portion of Medicaid funding; Coffman says it’s about 10 percent.
Under his proposal, anyone enrolled under expanded Medicaid before 2020 would remain on the 90-10 split rolls, and states like Colorado that expanded Medicaid would pay half of the funding for any Medicaid expansion recipients added after the start of 2020.
“It makes no sense to me for the federal government, under the ACA, to pay 90 percent or more for an able-bodied adult without dependent children, but 50 percent for a disabled child,” Coffman said.
“We need to bring that program in alignment with all other Medicaid programs, and there's roughly a 50-50 split between the state and federal government,” he added, describing his proposal as a “gentle phase in,” while acknowledging the cost to states.
About 400,000 people are covered under expanded Medicaid in Colorado, according to the nonpartisan Colorado Health Institute.
CHI estimated that under the Senate’s first health care bill, the state would lose more than $15 billion in federal money by 2030, and 628,000 Coloradans would lose coverage because of the rollback in Medicaid expansion funding.
But Coffman was adamant that the states would have to bear more of a responsibility in the expanding Medicaid budget.
“It will put more pressure on the states,” said Coffman, explaining that changes must be made to replace an “inefficient program without good outcomes.”
His proposal also contains a mandatory work requirement that would force people enrolled in the expanded Medicaid program to be working, actively seeking a job, or enrolled in a job training program.
He also says that part of the Medicaid reform efforts he’s proposed through reconciliation will address some of the taxes contained within the ACA that affect lower- and middle-class Americans.
Prongs 2 and 3: Tax reform and marketplace changes
The second prong would be part of reforming the nation’s tax code, and would address some of the taxes imposed on hospitals and wealthy Americans that many Democrats have expressed concern over when they were cut in the House and Senate versions of the new health care bills.
And the third prong, which Coffman admits could be the most difficult facet to achieve, is working with Democrats to address the health insurance exchanges that operate under the ACA.
He told Denver7 that the ACA did more to bolster Medicaid spending than to get all Americans private health insurance, and said he worries about the number of insurers leaving states’ marketplaces.
“This is clearly unsustainable and I am sure that we can work with our colleagues on the other side of the aisle to end this crisis,” Coffman said.
But it’s among the first olive branches congressional Republicans have offered publicly to Democrats, who have opposed bother chambers’ bills.
“I think first of all I need to convince Republicans to back away from doing this unilaterally,” said Coffman. “I think, together, Republicans and Democrats will be able to craft a solution that makes sense for the country. I think it is wrong for Republicans on such a critical piece to go forward alone on this.”
Reaction from Colorado mixed
Reaction to Coffman’s proposals in Colorado’s health care community was mixed Tuesday.
Julie Reiskin, the executive director of the Colorado Cross Disability Coalition, said the plan would address some of the concerns expressed by disability rights activists in recent nationwide protests.
“It would not decimate the traditional Medicaid,” said Reiskin. “What the other proposals were doing was they were just slashing Medicaid dramatically between 25-35 percent.”
While Reiskin said Coffman’s proposal appears to be a step in the right direction, she said many people with disabilities are covered under the Medicaid expansion as well, and would likely lose coverage in Colorado under his plan.
“If [the federal government] is going to go down to 50 percent, what will we do with those people? Because of TABOR we can’t just raise taxes,” said Reiskin. “We as a state made a decision based on a promise by the federal government, and just because the administration changes doesn’t mean the federal government can break that promise to us as a state.”
The Colorado Consumer Health Initiative didn’t have as rosy of an outlook, however.
"While Congressman Coffman is offering an alternative GOP healthcare bill that appears more thoughtful, it would still be a disaster for Coloradans who depend on Medicaid for their health care,” said CCHI Executive Director Adela Flores-Brennan. “The higher federal reimbursement is absolutely necessary to cover the many low-income individuals that can’t afford private insurance. And don't be fooled: per capita caps will only lead to cuts in Coloradans’ health care."
Flores-Brennan agreed that bipartisanship was necessary to truly fix concerns that both Democrats and Republicans have about the current health care system, but said that any solution shouldn’t result in people losing coverage or too much of the cost shifting back to the states.
"The Congressman is absolutely right that our members of Congress should work together to improve the private insurance market, both on and off the exchanges – but they must prioritize affordability provisions and consumer protections,” Flores-Brennan said. “We believe that any proposal adopted should ensure that Coloradans do not lose coverage and the Medicaid expansion is maintained without shifting unsustainable costs to the state."
Coffman said he had spoken to House Speaker Paul Ryan about his proposal on Tuesday after he sent the letter to Ryan and McConnell earlier in the day.
He will introduce his proposal Wednesday in front of House Republicans at a 9 a.m. meeting in Washington, D.C. Denver7 is expected to get more information on the proposal and its reception from Republicans on Wednesday after the meeting.