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After weeks of tug of war over the GOP bill to repeal and replace Obamacare, Utah Sen. Mike Lee has offered his ultimatum: Add an amendment to give insurance companies more flexibility in offering cheaper and less comprehensive plans or count his vote as a "no."
"The last iteration of the Senate bill is one that I cannot support," the conservative senator said during a news conference Tuesday in Washington.
The Consumer Freedom Option, which Lee drafted with Republican Sen. Ted Cruz of Texas, would allow insurers to offer any plan they want as long as they provide one option that complies with Obamacare regulations (including coverage for pre-existing conditions and preventive care). Lee also supports allowing individuals to use pretax dollars to pay their premiums.
"That's one way to get me to 'yes' on the bill," he said. "If it's not that particular amendment, some other form of meaningful relief from the Title I regulations in the Affordable Care Act."
Without a change and with it Lee's and Cruz's support the Senate bill could be doomed. GOP leadership cannot afford to lose more than two of the 52 conservative senators. But adding an amendment could also alienate more moderate Republicans.
That precarious balance will be tested as the Senate continues to work on the health care bill in the coming weeks, possibly two weeks into the August recess, according to an announcement by Majority Leader Mitch McConnell, R-Ky., on Tuesday. A revised version of the legislation was expected to be released at week's end and voted on as early as next week. It's unclear if that will still be the case with the now-extended time frame.
Lee had joined a small group of senators earlier in the day in calling for a shortened or canceled recess, saying there's "an enormous amount of work to do."
"We respectfully request that you consider truncating, if not completely forgoing, the scheduled August state work period, allowing us more time to complete our work," the lawmakers wrote in a letter to McConnell.
The Cruz-Lee amendment has support from the White House. On "The Rush Limbaugh Show" on Monday, Vice President Mike Pence said the alternative plan is "what freedom looks like."
Utah Sen. Orrin Hatch was slightly less enthusiastic.
"I give them credit for trying to move the ball forward," he said. "In the end, it will be about the art of the doable, but I'm open to listening to any proposal that helps fix the current mess we're in."
Lee believes the amendment would bring down premiums for middle-class families, said the senator's spokesman, Conn Carroll. With a freer market and fewer regulations, he added, insurance companies could offer cheaper, skimpier plans to those who need less coverage. That would result in more choices for consumers.
But it would likely come at a cost.
Because premiums are calculated within risk pools, those with pre-existing conditions flocking to an insurer's one required Obamacare-compliant plan will "really drive up costs" for that group while healthy, young individuals opt for the less expensive, less regulated options, said Utah Health Policy Project's spokesman Jason Stevenson.
"It would be like the Wild West of health care," he said.
Over time, the premiums would skyrocket for sick and older people until it created a "classic death spiral," Stevenson added, and the market collapsed. It's the same argument Democrats have presented against the amendment. Senate Majority Leader Chuck Schumer, D-N.Y., called the measure "a hoax."
"Americans with pre-existing conditions will almost certainly be left without access to affordable and quality health care," he said in a statement, "making this even worse than the House bill on this issue."
The House passed the first version of the GOP health care bill in early May one that the Congressional Budget Office estimated would mean coverage for 23 million fewer Americans by 2026 than currently. The Senate has been rewriting and revising the legislation since, but was stalled by in-party disagreements.
President Donald Trump hailed the House bill as a "great plan" before he criticized it as "mean" in a later meeting with senators.