At least four
Republicans could oppose a key procedural vote to call up the bill. And the
party remains deeply divided after a CBO report estimating 22 million fewer
Americans would have insurance under the plan.
06/26/2017 08:29 AM
EDT Updated 06/26/2017 07:47 PM EDT
Senate Republicans’
Obamacare repeal effort is on track to blow up before it even gets started.
The GOP is well short
of the votes needed to bring its bill to the floor, and party leaders and
President Donald Trump are kicking into overdrive to save their imperiled
health care overhaul.
At least four
Republican senators, Susan Collins of Maine, Rand Paul of Kentucky, Dean Heller
of Nevada and Ron Johnson of Wisconsin, have signaled they could oppose a key
procedural vote that will occur either Tuesday afternoon or Wednesday. A number
of other senators, like Shelley Moore Capito of West Virginia and Marco Rubio
of Florida, are undecided.
Senate Majority
Leader Mitch McConnell (R-Ky.) and his team are working furiously to round up
50 of the caucus’s 52 senators to even bring the bill to the floor, let alone
pass it by week’s end.
GOP leaders said
ultimately that even lawmakers who oppose the bill in its current form could be
persuaded to allow the debate over the party’s long-sought Obamacare rollback
to begin.
“I would hope … our
members would at least let us get on it,” said Sen. John Thune (R-S.D.), the
No. 3 GOP leader. “Everybody wants to exert whatever leverage that they can,
where they can get the most leverage, but I would expect we’d be able to get on
the bill.”
“I think we’re going
to be in a good place,” added Senate Majority Whip John Cornyn (R-Texas), the
party’s chief vote counter.
Simply overcoming the
hurdle is becoming a massive headache for Republican leaders, and the Senate
GOP seemed more divided than ever after the release on Monday of the
Congressional Budget Office’s analysis.
CBO estimated that 22
million more people will be uninsured over the next decade, but in good news
for Republicans, the agency also gave them nearly $200 billion more to spend on
the legislation to win over wavering senators with additional federal
assistance.
Senators from
Medicaid expansion states huddled on Monday evening, hoping to persuade
McConnell to pour more money into Medicaid and opioid treatment, but budget
hawks are eyeing an opportunity to pocket the savings and decrease the deficit.
“We’re trying to
accommodate [senators’] concerns without losing other support,” Cornyn said.
Trump and GOP
leadership are doing all they can to tamp down criticism of the legislation and
a voting timetable that will provide perhaps just a couple of days for senators
to review the final product before a vote.
But those efforts
have been complicated by the Trump-linked super PAC America First Policies and
its plans to attack Heller and four conservative senators for balking at the
bill.
Sources close to
McConnell said they were concerned the effort could backfire and jeopardize the
entire bill by angering Heller, Johnson, Paul and Sens. Ted Cruz of Texas and
Mike Lee of Utah.
“It’s certainly not
helpful,” said one of the sources. The second source called the effort
“buffoonish.”
The party will meet
in a full caucus lunch on Tuesday for a gut check and some senators will dine
with Vice President Mike Pence on Tuesday evening.
In the interim, many
senators refused to divulge their positions on the bill Monday as the whip
effort from McConnell and Cornyn stepped up and the CBO score came down. Sen.
Joni Ernst (R-Iowa), a conservative from a Medicaid expansion state, said
simply: “I do have an opinion, but I’m not going to share it.”
McConnell worked on
wavering senators by phone over the weekend, Republican sources said, and Trump
called undecided GOP senators including Cruz, Johnson, Paul and Capito to feel
them out on health care, said White House press secretary Sean Spicer on Monday
afternoon.
Johnson said in an
interview late Monday that he made the argument to Trump that “this bill
doesn’t do anything near enough to address the price of premiums.” And the
president, Johnson said, was “sympathetic” to his argument.
“I’ve been very upfront with leadership for
some time: Don’t jam us, don’t jam the American public,” Johnson said. “I have
a hard time believing I’m going to have the information to vote for a motion to
proceed.”
The conservative
Wisconsinite said McConnell should delay the vote for two weeks and also complained
that conservatives’ suggestions to alter the bill in the Senate’s working group
were mostly ignored. Similarly, Paul said McConnell and his team are doing
little to woo him.
“I had a long
conversation with the president last night and I think he’s open to
negotiations, but we have not had any word from anyone in Senate leadership,”
Paul said in an interview.
The CBO score could
complicate things further. In addition to showing large coverage losses,
including 15 million fewer insured next year, the agency projects that the
Senate bill’s Medicaid changes would result in a 26 percent decline in spending
on a program that covers low-income Americans. Obamacare significantly expanded
the program.
“I’m not happy with
the score,” said Heller, the most vulnerable Senate Republican in 2018.
CBO also projects
that insurance premiums would rise over the next year, a major problem for
conservatives.
Powerless Senate
Democrats, shut out of a process that can circumvent filibusters, seized on the
CBO report to slam the bill.
The legislation
amounts to a massive redistribution of wealth that “will force millions of
Americans to spend more of their paychecks on health care to receive fewer
benefits simply so the wealthiest Americans pay less in taxes,” said Senate
Minority Leader Chuck Schumer of New York.
Despite some calls by
Republicans to delay the vote into next month, most in GOP leadership believe that
letting the bill hang out over the Fourth of July recess will result in more
“no” votes and slow the GOP’s momentum. The president also suggested that the
party could let insurance markets collapse if the bill fails this week.
Republicans say
McConnell is ready for the vote to happen, even as they are uncertain about the
prospects — eager to move on from the issue one way or another.
“I’m more nervous
than I was on Friday. I still think we can solve the problems that a couple of
members have brought up,” said Sen. David Perdue (R-Ga.).
Adding to the GOP’s
problems, the American Medical Association — the nation’s largest physicians
professional group — announced its opposition to the Republican bill Monday
because it would violate medicine’s standard to “first, do no harm.”
Republicans did get
one nod of approval. Insurance company Anthem said the Senate bill “will
markedly improve the stability of the individual market and moderate premium
increases” but acknowledged the company is still reviewing the “challenges the
current bill proposes” to Medicaid.
Republicans released
updated text on Monday intended to promote continuous health coverage, which
was left out of the discussion draft released Thursday and is designed to
encourage people to buy insurance ahead of an emergency. An additional rewrite
is expected shortly before the motion to proceed to the bill, with additional
horse-trading expected on the Senate floor, potentially in the form of
amendments.
The revised Senate
bill would include a six-month “lock out” period in which people who don’t have
insurance have to wait before their policy takes effect. The lock out would
apply to people who have been uninsured for at least 63 days; people would not have
to pay their premiums during that time. The House bill would have allowed
insurance companies to charge uninsured people up to 30 percent more for up to
one year.
Those provisions
represent the GOP alternative to Obamacare’s individual mandate, which is
deeply unpopular but helps keep insurance markets afloat.
Because Republicans
are keeping the popular requirement that insurance companies accept everyone
regardless of pre-existing conditions, which is expensive for insurance
companies, the GOP needs some policy to encourage people to buy insurance.
Without it, insurance companies would experience a death spiral of too many
costs coming in without enough healthy people on the rolls to balance them out.
A White House
official said there will be big changes to the bill after the CBO score which
will determine “how much can be given to the moderates.” The Senate bill saves
$188 billion more than the House bill, which means McConnell has significant
leeway to fund senators’ priorities.
Elana Schor, Seung
Min Kim and Josh Dawsey contributed to this report.
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