Policy

GOP Grapples With Path Forward for Health Care Plan

Some senators are clamoring for changes to the House bill

Senate Majority Leader Mitch McConnell, center, says his chamber will consider whatever the House comes up with on health care. (Tom Williams/CQ Roll Call)

By BRIDGET BOWMAN and JOHN T. BENNETT

Republicans grappled Tuesday with how to advance their health care proposal following a report from the Congressional Budget Office that the plan would dramatically increase the number of uninsured Americans.

House lawmakers had more time to digest the report thanks to a winter storm that delayed their schedule. But senators trudged through the slush and snow to the Capitol, where they faced questions about the CBO report that said the GOP plan would lead to 24 million more people uninsured by 2026, and reduce the deficit by $337 billion over 10 years.

Senate Majority Leader Mitch McConnell, who is scheduled to be with President Donald Trump in Louisville, Kentucky, on Monday, said his chamber would bring up whatever legislation the House produces as its base bill.

“We’re hopeful and optimistic they’re going to send us over something. It’ll be open for amendment. We’re going to do our thing, and pass it,” McConnell said.

Some Republican senators are pushing for changes to be made in the House before the bill is sent to the Senate.

“I’m doing all that I can to make the House bill as good as it can be,” said Tennessee Sen. Lamar Alexander, the Senate Health, Education, Labor and Pensions chairman, who is scheduled to rally with Trump in Nashville on Wednesday.

Health and Human Services Secretary Tom Price, Vice President Mike Pence, House Energy and Commerce Chairman Greg Walden, and House Ways and Means Chairman Kevin Brady discussed their path forward with GOP senators during the senators’ weekly Tuesday policy lunch.

“They were explaining what they were going to send over,” said Sen. John McCain, though he declined to go into detail. 

The Arizona Republican said he would wait until the House was finished amending the bill before deciding whether he could support it.

McCain is among several senators citing concerns about how the legislation would affect people in states that expanded Medicaid under the 2010 health care law. The CBO report estimated that by 2026, there would be 14 million fewer Medicaid enrollees under the GOP plan.

Kentucky Sen. Rand Paul, a conservative opposed to the House GOP plan, was not convinced after the lunch that there would be sufficient changes to the legislation. 

The lunch discussion “wasn’t a negotiating session,” he said.

“I don’t think they’ll have any changes or any compromise until they lose a vote,” Paul told reporters when asked if any changes to the House bill were discussed at lunch. “If they don’t lose a vote, this is what we’re getting.”

GOP leaders have said the bill put forward is the first step in a three-pronged approach that includes administrative changes and additional pieces of legislation. 

The Trump administration on Tuesday pressed House leaders to finalize and release the regulatory moves and follow-on legislation that compose the second and third “prongs” of the party’s overhaul strategy.

White House Press Secretary Sean Spicer said both Speaker Paul D. Ryan and Price are working on the regulations that he described as “fairly easy to do.”

“The sooner we can get all the prongs out, the better,” Spicer said.

A Ryan spokesman confirmed that his boss is not only working on the follow-on legislation, but also on the regulatory piece that would come from the executive branch.

Spicer continued to question the accuracy of the CBO report, contending that the second and third phases of the overhaul push would further drive down costs and insure more people than the CBO projected. However, he did not say how the office was supposed to evaluate information that has not yet been released.

Spicer cast the coming follow-on legislation as something that should easily pass the House and surpass the needed 60 votes in the Senate. A big reason, Spicer said, would be provisions to allow individuals to purchase health insurance across state lines and allow “small business[es] to group together.”

But to garner 60 votes in the Senate to end debate on additional legislation, Republicans would need the help of several Democrats. And, as Senate Minority Leader Charles E. Schumer indicated Tuesday, that’s not likely to happen.

The New York Democrat reasserted that his caucus would not negotiate on health care until repeal of the 2010 law is off the table.

Schumer, brandishing the CBO report, specifically dismissed the idea that the health care system would cover more people and insurance would be more affordable after Republicans advance the second and third prongs of their plan.

“This bill digs them so deep in a hole that no regulations are going to get them out of that,” he said. “On the changes, they need 60 votes.”

Conservative Sen. Tom Cotton also criticized the three-step approach during an appearance on the Hugh Hewitt radio show Tuesday morning. 

“There is no three-phase process. There is no three-step plan. That is just political talk,” the Arkansas Republican said.

Cotton said any regulatory changes Price makes would be subject to a court challenge and that “step three” of additional legislation was a myth. He said if Republicans could get Democrats onboard with future legislation, they would have done so at the outset, instead of moving the legislation, or first prong, forward through a budget process that only requires a majority of senators’ support. 

“That’s why it’s so important that we get this legislation right, because there is no step three. And step two is not completely under our control,” Cotton said.

Trump’s top spokesman acknowledged that Republicans might only get one try at dismantling former President Barack Obama’s signature health care law and replacing it with one of their own.

“If we don’t get this through,” Spicer said of the bill working its way to the House floor, achieving the party’s ultimate goal “will be extremely difficult.” 

Erin Mershon and Niels Lesniewski contributed to this report.

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