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Hours before its planned public release, Utah Sen. Mike Lee has yet to see the Senate's revised bill to repeal and replace Obamacare and he isn't sure whether it will include his do-or-die amendment.
"[It] is a bill that still doesn't exist to my knowledge … That's one of the reasons why I can't tell you if I'm going to vote for or against it," he said during a tele-town hall Wednesday night. About 13,000 people listened to the event by phone and 678,000 watched online, according to Lee's staff.
The Republican senator adamantly supports a proposal to allow insurance companies to offer cheaper and less comprehensive plans. If that provision or something like it is not included in the legislation unveiled Thursday, Lee has promised to vote "no."
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 believes that would reduce premiums for middle-class families. With a freer market and fewer regulations, he said, insurance companies could offer cheaper, skimpier plans to those who need less coverage.
In explaining how he sees the amendment as improving upon the Affordable Care Act, Lee compared health care coverage to car insurance.
"Imagine if car insurance companies were required to charge everyone the same car insurance rate regardless of how likely they were to get into an accident," he said. "Those of you who are older and perhaps have good driving records no tickets, no accidents would be forced to pay higher insurance premiums. You'd, in effect, be subsidizing younger and riskier drivers while not receiving a reward for your safe driving. This is sort of like what's happening under Obamacare."
With the current health care system, the senator said, healthy, middle-class families are burdened with the costs of covering sicker individuals who need more care. His proposal would instead lump those with pre-existing conditions and specialized needs into a segregated risk pool while freeing up other individuals to select less expensive plans.
And he hedged a bit on his analogy.
"Now, of course, I understand car insurance and health insurance are very different products," Lee added. "People can choose not to drive, but many people need health care in order to survive."
A member of Utah's congressional delegation, now former Rep. Jason Chaffetz, previously came under fire for suggesting that "rather than getting that new iPhone" low-income individuals may have to prioritize paying for health insurance.
Lee's metaphor, though, doesn't holdup to predictions from Utah Health Policy Project, a nonprofit that helps residents enroll in coverage.
Because premiums are calculated within risk pools, those with pre-existing conditions flocking to an insurer's lone required Obamacare-compliant plan would drive up costs for that group while healthy, young individuals opt for the less expensive, less regulated options.
Over time, the organization argues, premiums would skyrocket for sick and older people under the Lee-Cruz amendment until the market collapsed.
Additionally, the nonpartisan Kaiser Family Foundation estimates that 1.5 million people with pre-existing conditions could face higher premiums under the proposal. Health insurance lobbying groups have also spoken out against Lee's measure.
The senator's 57-minute online town hall, where he addressed 15 questions on health care, had brief spots of tension along those lines. One participant accused Lee of bias because he's "taking that kind of money from Big Pharma."
"I completely resent your suggestion of any influence being exercised by any particular group. I routinely vote against anything that pharma suggests. If people who are employed or affiliated in some way with pharma have donated to my campaign, that's their decision, but they know …" he said before being cut off by the questioner.
"Yes, but you took that money," she interrupted.
"If there are people that are associated with that organization that want to contribute to my campaign, that's their decision," Lee continued. "But they know that I don't work for them."
From 2011 to 2016, Lee has received $74,500 from pharmaceutical and health political action committees, according to the Center for Responsive Politics. He's received more PAC contributions from the oil and gas and legal industries.
Another caller said the Senate's proposal would terminate his family's coverage for pre-existing conditions.
"We still haven't seen final language," Lee responded, "but none of [the plans] would leave you out in the cold or without options if you maintain continuity of coverage."
Ultimately, the senator said, he wants to make insurance more affordable and he'll vote for a plan that accomplishes that.
Senate Republicans will meet with Majority Leader Mitch McConnell on Thursday morning to discuss the bill. Without a significant change and with it Lee's and Cruz's support the legislation could be doomed. GOP leadership cannot afford to lose more than two of the 52 conservative senators.
The Senate will work possibly two weeks into the August recess to finesse that precarious balance. A vote, though, is anticipated as early as next week.