Senate GOP Health Care Bill Faces Crucial Week, And Many Doubts
Senate Majority Leader Mitch McConnell has set a deadline of Friday for a final vote on the Senate GOP’s version of health care reform, but it’s looking increasingly unlikely that he’ll get there:
WASHINGTON — Senate Republican leaders scrambled Sunday to rally support for their health care bill as opposition continued to build inside and outside Congress, and as several Republican senators questioned whether it would be approved this week.
President Trump expressed confidence that the bill to repeal the guts of the Affordable Care Act would pass.
“Health care is a very, very tough thing to get,” Mr. Trump said in an interview shown Sunday on Fox News. “But I think we’re going to get it. We don’t have too much of a choice because the alternative is the dead carcass of Obamacare.”
With Democrats solidly opposed to the legislation, Senate Republicans must find the votes from within. They can afford to lose only two votes, but five Republican senators have announced that they cannot support the health care bill as drafted, and others have expressed concerns.
Senate leaders have been trying to lock down Republican votes by funneling money to red states, engineering a special deal for Alaska and arguing that they could insure more people at a lower cost than the House, which passed a repeal bill last month.
But as more analysis of the bill reached state officials, especially in places that expanded Medicaid access under the Affordable Care Act, misgivings grew. Senator Bill Cassidy, a Louisiana Republican and doctor who is considered a critical vote, said he remained undecided. Louisiana, with its high levels of poverty, recently expanded Medicaid.
“There are things in this bill which adversely affect my state, that are peculiar to my state,” Mr. Cassidy said on CBS’s “Face the Nation.”
The bill was drafted in secret, mainly by the Senate majority leader, Mitch McConnell of Kentucky, who unveiled it on Thursday. Mr. McConnell wants a vote this week, before lawmakers take a break for the Fourth of July holiday.
Senator Jerry Moran of Kansas, usually a reliable vote for Senate Republican leaders, said on Fox News, “I just don’t know whether the votes will be there by the end of the week.”
Over the weekend, senators and their aides were poring over the bill, drafting possible amendments, preparing speeches and compiling personal stories from constituents whom they portrayed as either beneficiaries or victims of the Affordable Care Act.
But the bill’s supporters were battling an internal threat: reluctant Republicans. Senator Ron Johnson of Wisconsin said Sunday that “there’s no way we should be voting” on the legislation this week. “No way.”
“I have a hard time believing Wisconsin constituents or even myself will have enough time to properly evaluate this for me to vote for a motion to proceed,” Mr. Johnson said on NBC’s “Meet the Press.”
And Senator Susan Collins, Republican of Maine, said on ABC’s “This Week”: “It’s hard for me to see the bill passing this week, but that’s up to the majority leader. We could well be in all night a couple of nights.”
The U.S. Chamber of Commerce, the National Federation of Independent Business and the National Retail Federation have all said they support the bill. Thomas J. Donohue, the president of the Chamber of Commerce, said it would “help stabilize crumbling insurance markets” and eliminate “ill-conceived Washington mandates and taxes.”
But much of the nation’s $3 trillion health care industry opposes the bill. And Mr. McConnell has done little to woo the health care stakeholders whom Mr. Obama courted assiduously from his first months in office.
The concerns expressed by outside groups also appear to be growing. Top lieutenants in Charles G. and David H. Koch’s political network sharply criticized the legislation over the weekend, saying it was insufficiently conservative and did not do enough to rein in the growth of Medicaid. And a number of Republican governors have joined doctors, hospitals and patient advocacy groups in opposing the bill, in part because of its cuts to Medicaid.
Mr. McConnell has only a few days to wheel, deal and cajole reluctant senators to get behind legislation that has grown less popular with more exposure. He has considerable firepower to win votes by guaranteeing amendments that would address the concerns of individual Republican senators, and by playing on their loyalty to him and to conservative voters still demanding an end to the Affordable Care Act. At the same time, Democrats say, he has striking liabilities. Mr. Trump has endorsed the bill, and Democrats say they will take every opportunity to link the legislation to an unpopular president.
And the Democratic wall of opposition is backed by less partisan voices. Senators are being flooded with appeals like this from the advocacy arm of the American Cancer Society: “Cancer is scary enough. Don’t take away our coverage.”
The American Childhood Cancer Organization, a charitable group formed by parents, is mobilizing a small army of grass-roots lobbyists with the message that the bill, with its deep cuts to Medicaid, “will threaten the lives of children battling cancer.”
The United States Conference of Catholic Bishops said the Senate bill was “unacceptable as written” and would “wreak havoc on low-income families.” At the same time, the bishops said they liked two sections that seek to “prohibit the use of taxpayer funds to pay for abortion or plans that cover it.”
Republicans are finding allies to be few and inconstant. Mr. Trump has said he is “very supportive” of the Senate bill. But that support will be of limited help to Mr. McConnell. Few senators feel loyal to Mr. Trump, whose erratic message has often weakened his influence on Capitol Hill.
After pushing for passage of the House repeal bill, he criticized it as “mean” several weeks later. A spokeswoman, Sarah Huckabee Sanders, said last week that Mr. Trump did not necessarily support cuts to Medicaid, even though his budget and the Senate bill would make such cuts.
Meanwhile, Politico is reporting that an increasing number of Republicans in the Senate are expressing doubts that McConnell’s end of the week timetable is one that can withstand the mounting political pressure it will be facing over the coming week. Several of the Senators who appeared on the morning shows yesterday, for example, were openly calling for more time for members to evaluate the bill and hear from their constituents. One of the strongest voices on that point has been Wisconsin Senator Ron Johnson, who was just re-elected last November after a closely fought race with former Senator Russ Feingold. While it hasn’t adopted the Medicaid expansion offered by the PPACA, Wisconsin is a state that has seen a significant increase in the number of patients enrolled in Medicaid since the passage of the PPACA and the state has benefited from the Federal subsidies that the law provides for Medicaid programs that would be ended by the Senate bill. There’s been no comment yet from McConnell or anyone in the Senate GOP leadership about the timetable for the bill, but with Senators returning to work today from the weekend, it’s likely that they’ll have to say something soon.
As it stands, though, there are at least five Republican Senators who are on record as opposing the bill, with the most recent addition to that list being Dean Heller from Nevada, who is widely seen as being the most vulnerable Republican Senator on the ballot next year. Three of the remaining four consist of some of the most conservative members of the Senate, Rand Paul, Ted Cruz, and Mike Lee. Johnson of Wisconsin, who I made note of above is the fourth. Beyond these five, though, there are at least four other Senators whose support is in doubt for a variety of reasons. These include Rob Portman of Ohio, Shelly Moore Capito of West Virginia, Lisa Murkowski of Alaska, and Susan Collins of Maine. As I noted late last week, this puts McConnell and the Senate GOP leadership in the difficult if not impossible situation of trying to find a way to fix the current version of the bill to appease at least nine Senators, each of whom has their own objections to the bill and each of whom comes to their opposition for different political reasons. As it stands, losing more than two Senators means the bill would go down to defeat, and it seems unlikely that they’ll be able to appease everyone in time for a final vote on Friday.
Further complicating matters for McConnell will be the upcoming report from the Congressional Budget Office, which will release its score of the Senate bill sometime early this week, possibly as early as this afternoon. The key numbers took look for in that report will be the estimate of the number of people who are likely to lose insurance coverage because of the Senate bill and the forecast about what impact the bill is going to have on premiums and deductibles. If the CBO reports on the two versions of the House health care bill — which I wrote about here and here — are any guide, then we’re likely to see the number of uninsured increase and no indication that the Senate bill will do anything to reduce premiums, deductibles, or health care costs. If that’s the case, then it’s likely that will just increase the pressure on Senate leadership to either delay the final vote or go back to the drawing board.