Senate to push for health care debate, but which plan?

The U.S. Senate is scheduled to vote Tuesday to kick off debate on legislation that would repeal Obamacare, but what’s in store is still a mystery.

Majority Leader Mitch McConnell has yet to disclose whether he plans to immediately push a replacement for the 2010 health care law or simply a repeal-only plan, much like what the Senate voted on two years ago. Working with the slimmest of GOP majorities, it remains to be seen whether he has enough votes to advance either.

President Donald Trump held a dramatic press conference at the White House to press senators of both parties on the issue Monday. Standing in front of a handful of families he termed “Obamacare’s victims,” Trump excoriated the Democrats for their part in passing the Affordable Care Act in 2010 and defending it now.

“They run out, they say: death, death, death,” Trump said. “Well, Obamacare is death. That’s the one that’s death.” He also urged every Republican to back the repeal effort.

Both Georgia senators, Republicans David Perdue and Johnny Isakson, voted for a repeal-only effort in December 2015, when there was no political risk as it was headed for certain veto.

But with the GOP in control of the White House and both chambers of Congress for the first time in a decade, the pressure is suddenly immense. The health insurance of up to 1 million Georgians is at stake.

Both Isakson and Perdue have indicated they plan to vote for their party’s Obamacare replacement plan should it come up for a vote.

But when it comes to a repeal-only measure, while Perdue has said definitively he’ll back it, lately Isakson has been more opaque.

When a similar proposal was floated earlier this year, Isakson said it would be “wrong” to repeal the Affordable Care Act without a workable replacement plan ready.

Isakson is seen as a loyal ally to McConnell and is not generally expected to vote against the majority leader’s health care plan. However, he’s dodged the question of whether he would support a repeal-only effort in recent days as it became clear McConnell might resort to such a plan.

“I’m not going to answer a specific question when there’s not a plan,” Isakson said last week.

Campaign promises

The GOP has hung its hat for years on its desire and ability to nullify and replace Obamacare. But now, with control of both chambers of Congress and the White House for the first time in a decade, the Republican effort appears to be teetering on the verge of failure, the victim of a host of internal divisions over the role of government in health care and particularly Medicaid.

Rampant uncertainty about how the Republican Congress will proceed is having a ripple effect in states such as Georgia, where stakeholders — including Obamacare customers, insurers and medical providers — are on edge about their futures.

Earl Rogers, who advocates for Georgia hospitals, said in a statement that both GOP bills would “restructure Medicaid and bring sweeping changes to insurance markets” in a way that would hurt hospitals.

“The Georgia Hospital Association expressed serious concerns to Senators Isakson and Perdue regarding many of these provisions, which would result in lost health coverage and reduced benefits and eligibility for tens of millions of patients,” Rogers said, “as well as deep cuts to the Medicaid program that would force increased uncompensated care for providers.”

Advocates for the poor, rural residents and the underserved, noted that Trump actually had a point with some of his critiques of health care.

For example, premiums are rising too high for many families, and insurance networks are getting too narrow for some patients, they said. They said, however, that the administration’s approach was cynical and not geared to help.

“The way to fix that is the opposite of essentially what would be happening in the Senate bill,” said Laura Colbert, the director of outreach for the patient advocacy group Georgians for a Healthy Future.

Monty Veazey, the president of the Georgia Alliance of Community Hospitals, flatly states that access to health care in rural Georgia is terrible and “it’s getting worse not better.” But he, too, fears the Senate plan.

“It will absolutely worsen the problem — greatly,” Veazey said. “I don’t think that’s what they want to do.”

But Georgians pushing for repeal were no less blunt.

“Senators, we are watching,” tweeted U.S. Rep. Doug Collins, R-Gainesville. “Let’s get to work and repeal #Obamacare!”

That puts immense pressure on Isakson and Perdue, who must contend with their party, base voters, campaign pledges and the roughly half-million Georgians who rely on the Affordable Care Act’s exchanges for their health care.

Trump tweeted that if GOP lawmakers failed to repeal and replace the health care law, “the repercussions will be far greater than any of them understand.”

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