Editor's note: This story was updated at 7:20 a.m. July 26.
Despite misgivings about the closed-door process used to write a bill to repeal and replace the Affordable Care Act and its potential impact on rural health care providers, Republican U.S. Sen. Jerry Moran joined his Kansas counterpart, Pat Roberts, in voting Tuesday to begin debate on the legislation.
But a short time later, Moran was one of nine GOP senators who voted against a replacement bill backed by Republican leaders.
In an interview with KCUR after the procedural vote, Moran said he supports a bill that would repeal Obamacare and give Congress up to two years to work on a bipartisan replacement.
“Trying to do something with one party alone is a mistake,” Moran said. “I’ve called for all 100 senators to be involved in the process by which we repeal and replace or we fix the Affordable Care Act.”
Moran said the replacement bill defeated Tuesday night — known as the Better Care Reconciliation Act, or BCRA — wouldn’t have done enough to slow the rising costs of health coverage or provide sufficient protections for Kansans with disabilities and pre-existing conditions. In addition, he said he feared the Medicaid cuts it called for would have jeopardized rural hospitals and nursing homes.
He said those concerns must be addressed in future versions of the bill to secure his vote.
“If the end result of where we’re headed is just another version of something similar to the BCRA, I’m still a ‘no,’” he said.
Before Tuesday’s Senate votes, demonstrators in the U.S. Senate gallery shouted, “Kill the bill” and “Don’t kill us, kill the bill.” Guards quickly removed them, but their chants echoed in the hallway outside the chamber as the voting proceeded.
Arizona Republican Sen. John McCain made a dramatic return to the Capitol to vote in favor of the procedural motion to begin debate. Vice President Mike Pence cast the deciding vote, breaking a 50-50 tie.
Members on both sides of the aisle greeted McCain — whom doctors diagnosed with a brain tumor last week — with applause as he entered the chamber.
After the initial vote, McCain urged his colleagues to work together on a compromise bill that both Republicans and Democrats could support.
His remarks resonated with Moran.
“Because of his history, his personal experiences, the character that he’s demonstrated, I thought today was a great day to hear what Senator McCain had to say and I hope that it is taken to heart,” Moran said.
Despite Moran’s calls for a bipartisan solution, his vote to advance the repeal process disappointed Kansans fighting to save both Obamacare and the state’s opportunity to expand KanCare, its privatized Medicaid program.
“Our senators had the opportunity to put Kansans first and vote against the motion to proceed,” said David Jordan, executive director of the Alliance for a Healthy Kansas, an advocacy coalition funded by several regional health foundations.
“Had they voted against the motion, it would have shown that they were serious about an open legislative process that sought bipartisan agreement on improving the health care system and making it work better for Kansans,” Jordan said.
Brad Linnenkamp, a Kansan with disabilities from Lawrence, said he would be among those on the phone to Moran’s office.
“I think in the long run we can get him to turn around, and hopefully that could turn the tide in the right direction,” Linnenkamp said Tuesday at a Kansas Statehouse event staged by disability advocates opposed to repeal of the ACA.
The Republican repeal and replace bills considered so far would prohibit Kansas lawmakers from expanding Medicaid coverage to low-income adults as 32 states and the District of Columbia have done.
Those bills also would reduce federal Medicaid funding by more than $700 billion over 10 years.
An analysis done for the Alliance for a Healthy Kansas by Manatt Health shows that the block grant plan in the Senate’s repeal and replace bill would require the state to replace nearly $1 billion in federal Medicaid funding between 2020 and 2026.
Another study, this one by the Urban Institute, estimated that 100,000 Kansans would no longer have health insurance by 2022 under the Senate bill.
“Any bill that causes more than 100,000 Kansans to lose their health coverage, raises costs for others, particularly older and lower-income Kansans, and guts Medicaid takes us backward,” said Sheldon Weisgrau, director of the foundation-funded Health Reform Resource Project.
Moran said while he opposes the proposed cuts to Medicaid, he doesn’t believe the federal government can afford the long-term costs of expansion.
Under the ACA, the federal government is obligated to cover no less than 90 percent of the cost of extending Medicaid benefits to millions of low-income adults who previously didn’t qualify for the health insurance program.
The Urban Institute study estimated that expansion would provide coverage to an additional 146,000 Kansans and increase federal Medicaid funding to the state by $10.3 billion between 2017 and 2026.
Jim McLean is managing director of the Kansas News Service, a collaboration of KCUR, Kansas Public Radio and KMUW covering health, education and politics. You can reach him on Twitter @jmcleanks. Kansas News Service stories and photos may be republished at no cost with proper attribution and a link back to kcur.org.