Provisions shoehorned into the Republican healthcare bill dangle extra money for Alaska and Wisconsin, home states of one Republican senator whose vote party leaders desperately need, and another who cosponsored the legislation, analysts who have studied the legislation said.
The 140-page measure, which top Republicans hope to push through the US Senate next week, is stuffed with language making some states winners and others losers.
Aides say the legislation is still changing as leaders hunt the 50 Republican “Yes” votes they will need to turn this summer’s jarring Senate rejection of the party’s crusade to erase former US president Barack Obama’s law into an eleventh-hour triumph.
Alaska is home to Republican Senator Lisa Murkowski, who is among a handful of Republicans who have not said how they will vote.
Republican Senator Ron Johnson of Wisconsin is one of the bill’s cosponsors and his support is not in question, but the episode suggests the value of helping craft of legislation.
The bill was chiefly written by Republican senators Bill Cassidy and Lindsey Graham. It would end Obama’s Medicaid expansion and subsidies for people buying private insurance and combine the money into new block grants for states.
With all Democrats opposed, Republicans controlling the Senate 52-48 can lose only two votes if they are to succeed, leaving the bill’s fate uncertain.
Generally, it would shift money from states that expanded their Medicaid programs for the poor under Obama’s statute, which tend to be run by Democrats, to the largely Republican-run states that shunned that expansion.
The measure would shield Alaska from some cuts it imposes on Medicaid, according to analysts, including from the nonpartisan Kaiser Family Foundation, by limiting spending to a maximum amount per beneficiary starting in 2020.
The federal-state program for low earners has always automatically provided whatever money is needed for eligible recipients.
Montana would also qualify for the exemption.
It would also increase federal Medicaid funds for states with high Native American populations, including Alaska, healthcare consultant April Grady said.
Analysts offered no figures about how much money the provisions would mean for Alaska.
The provisions hardly ensure support from Murkowski, who has said she is studying how the measure would affect her state.
The administration was pushing for her support, with US Vice President Mike Pence calling into an Anchorage talk-radio show on Thursday and urging listeners to contact Murkowski and ask her to “stand with President Trump” and support the bill.
According to studies released this week by Kaiser and the consulting firm Avalere Health, Alaska is among many states that would lose money overall under the bill.
Alaska has unusually high healthcare costs because of the remoteness of many communities.
The provisions do not mention Alaska or Wisconsin by name.
However, the bill allows a state that turned down extra federal funds to expand Medicaid under Obama’s statute to count the rejected money in determining how large its block grant will be, analysts say.
Grady, Avalere analyst Chris Sloan and others said they were unaware of states other than Wisconsin that would benefit from the provision.
This language could mean “potentially hundreds of millions” of extra US dollars for Wisconsin, Grady said.
In a written statement provided by aides, Johnson said funding formulas to correct “the grossly unfair” distribution of money under Obama’s law needed to be changed “to reflect the unique circumstances of many states, including recognizing the innovative reforms of Wisconsin.”
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