The Republican effort to overhaul the U.S. health insurance system appears to be floundering, as GOP senators await additional details on a new draft of the legislation.
While the initiative remains in limbo, more lawmakers are openly exploring the possibility of a bipartisan health care bill. Discussions have been very preliminary, lawmakers say, and such a measure will not be easy to advance, as Democrats and Republicans are miles away on some policy ideas.
Still, members such as Sen. Lindsey Graham, R-S.C., say they are working with governors and Democratic senators on such a measure.
Republicans will first look for closure one way or the other on their own partisan legislation. Updated language in the GOP bill to repeal and replace portions of the 2010 health care law is expected to be released by Senate Majority Leader Mitch McConnell on Thursday, with a procedural vote on the measure likely to occur early next week.
But some Republican senators are already lambasting the changes.
“We’ve had time to hear what’s going to be in the new bill and as far as I can tell, the new bill is the same as the old bill, except … it leaves in place more taxes, increases taxpayer subsidies to buy insurance and adds about $70 billion to the insurance bailout superfund,” Sen. Rand Paul of Kentucky told reporters. “I can’t support it at this point.”
Senate GOP leadership was dealt another blow Wednesday when the insurance lobby came out strongly against an amendment from Sens. Ted Cruz of Texas and Mike Lee of Utah that the two lawmakers say is a necessary inclusion in order for them to support the bill.
McConnell can only afford to lose the support of two Republican senators, in which event he could turn to the tie-breaking vote of Vice President Mike Pence to pass legislation.
Amid the pushback, some lawmakers are discussing whether a smaller, bipartisan bill designed to stabilize the insurance markets could be done. McConnell has said such a measure may be necessary if the Republican effort fails, as have some of his closest allies in the chamber.
A vehicle to carry it may already exist. Senate aides from both sides of the aisle say it is possible some stabilization provisions could be attached to a pending reauthorization of the Children’s Health Insurance Program, which expires at the end of September.
Still, neither political party is entirely confident the two sides can come together on a traditionally partisan policy area.
“I just don’t believe Democrats can work with us. Their base won’t tolerate it. The growing energy in the Democratic base is insisting on single-payer,” Sen. Marco Rubio, R-Fla., told reporters, referring to a system under which a public entity, such as the U.S. government, would handle the financing of health care.
When asked whether that was accurate, Senate Majority Whip Richard J. Durbin said, “If you take repeal off of the table, … we’re ready to sit down.”
“The Republicans I’ve spoken to are waiting for the disposition of the current Republican bill before they initiate the bipartisan effort,” the Illinois Democrat said.
A main sticking point for Democrats is the changes to Medicaid the GOP is considering. In the current draft of the Republican bill, the 2010 health care law’s expansion of the entitlement program would be gradually phased out, ending completely in 2024. A stricter Medicaid growth rate would be applied in 2025, essentially reducing the amount of federal dollars directed to states for the program.
“If [Republicans] abandon the cuts in Medicaid and using that money to fund tax cuts, and just focus on the private insurance exchange, I think there are things that we could do,” said Michigan Democratic Sen. Debbie Stabenow.
A hard sell
That could be a hard sell for some GOP members, who see this opportunity as a once-in-a-lifetime chance to push forward a major overhaul of the entitlement program.
“Bottom line is, how do we make Medicaid sustainable, do so in an overall health package, and make sure we address the collapse of Obamacare,” said Sen. Cory Gardner of Colorado, whose state adopted the Medicaid expansion under the health care law. “Seems like there is a lot of firewalls that are put around conditions to work together that make it sound like they don’t want to work together.”
Even the most ardent opponents of the current Republican plan doubt that a bipartisan effort would be successful.
“I’ve yet to meet a Democrat in Washington that will vote to cut a tax or will vote to eliminate a regulation,” Paul said. “If the Democrats were willing to work to pare back the regulations that have added cost to health insurance, yeah, we’d work [with] them. There’s just no evidence [of that].”
Many GOP lawmakers declined to opine on whether a bipartisan deal would be necessary and instead chose to hold out hope that the current Republican effort would be successful.
“Until we get through doing what we are doing right now, which hopefully will be successful, to talk about any other route is not necessarily productive,” Tennessee Sen. Bob Corker said.