WASHINGTON — Conservatives are hailing a proposed change to the Senate health care bill by Texas Republican Sen.Ted Cruz allowing individuals to buy low-cost, bare-bones insurance covering catastrophic medical conditions. 

 

But while the suggestion could win over right-leaning holdouts before a planned vote on the legislation next week, it has alienated more moderate Republican senators like West Virginia’s Shelley Moore Capito and Iowa’s Chuck Grassley. 

 

Capito, in an interview Tuesday, and Grassley in a call with reporters Wednesday, said Cruz’s idea would make insurance unaffordable for people with pre-existing conditions.

 

 “I have some questions about what the ramifications are for people with pre-existing conditions in terms of pricing,” said Capito.

 

Cruz’s proposal is indicative of the dilemma Senate Majority Leader Mitch McConnell, R-Ky, faces in rallying a majority of Republicans to get behind the bill intended to replace the Affordable Care Act or Obamacare.

 

With Republicans holding only a two-vote Senate majority, McConnell needs revisions to win support from several conservatives and moderates who opposed the original draft of the bill unveiled two weeks ago.

 

The redone legislation, designed to muster enough votes for passage, is expected to be released Thursday. But any idea appealing to one side of the ideological divide could alienate the other. 

 

Indeed, on Wednesday, a key conservative holdout, Kentucky Republican Sen, Rand Paul, told reporters any effort to address moderates’ concerns over Cruz’s proposal would make the bill even more unpalatable to Paul.

 

In addition, Cruz’s approach does not address the concerns of Capito and other moderate Republicans about the $772 million in Medicaid cuts contained in the original bill. The new draft is not expected to make major changes in the cuts. 

Grassley said he’s “pessimistic” Republicans could come together behind a health care reform measure, even though he tweeted Saturday that the party would find itself going from the “majority to minority” if they cannot agree on a way to repeal Obamacare.

 

Cruz’s plan is aimed at a key concern of conservatives – Obamacare’s mandate that forces individuals to buy expensive insurance covering essential health services such as maternity and newborn care, mental health and substance abuse treatment.

 

His plan would allow insurance companies to sell catastrophic plans with low premiums that cover a limited number of conditions.

 

It would only be allowed if at least one insurance plan in a state met Obamacare’s requirement to cover a minimum set of essential health benefits 

 

Cruz’s plan would also get at the complaints of conservative senators that the original Senate health care bill doesn’t undo enough of the current law’s mandates, though it does eliminate the fines for not being insured.

Jenny Beth Martin, co-founder of the Tea Party Patriots, described Cruz’s proposal as a “common sense” amendment. She said it would allow “consumers to have more choice in what kind of insurance they want to buy and decrease the government mandating what you have to have.”

 

However, health care experts say Cruz’s plan could hurt Obamacare’s most popular provisions — a requirement that people with pre-existing conditions can get health coverage. 

 

The original Senate bill continues to preserve the current prohibition on insurers denying coverage to people based on their medical conditions, Critics like Families USA say mostly younger and healthier people will buy the cheaper plans, raising insurance rates to consumers with comprehensive coverage policies.

 

Cruz argues lower-income individuals with comprehensive plans would be shielded from increases if they qualify for current subsidies that make up the difference if premiums increase.

 

But to reduce federal health care costs, the Republican bill reduces the subsidies, requiring individuals to pay a higher share of their income for premiums as well as higher deductibles.

 

The liberal Center on Budget and Policy Priorities estimated a single 60-year-old making $42,000 per year would pay $5,763 more in annual premiums in Oklahoma, $5,523 more in West Virginia and $5,151 more in

Pennsylvania.

 

The center said deductibles for the 60ish group would increase by a national average of $3,000 to $6,000.

 

The high deductibles make essential health condition coverage worthless for low-income individuals, said Eliot Fishman, director of health policy at Families USA, and Cheryl Fish-Parcham, the group’s expert on private insurance.

 

Capito said she continues to be worried about the bill’s original language reducing the amount of federal money states receive if they expanded Medicaid to cover people making just above the poverty line. 

 

To check what conservatives say is the “unsustainable” growth of Medicaid spending, the GOP bill lowers the rate of traditional Medicaid spending and caps how much is spent on each person.

 

To win over Capito and other lawmakers worried that changes will lead to opioid addicts no longer being able to get help, Republican Senate leaders two weeks ago added $45 billion over ten years to help states pay for treatment.

 

However, addiction experts say those with drug problems would still be hurt by Medicaid cuts because they suffer from depression and other health problems that contributes to their addiction.

 

“Opioid addiction cannot be treated in isolation, and funding only addiction treatment when patients have other chronic and complex medical needs, is likely to be ineffective,” said Dr. Corey Waller, chairman of the American Society of Addiction Medicine’s legislative advocacy committee. “This approach just doesn’t make any clinical or economic sense.”

 

Capito agreed.

 “We have to look at the whole person,” she said. “People with opioid and other drug problems have other health issues, from HIV, to hepatitis, health and liver problems, mental health, depression and on and on.”