BY JOE WILLIAMS and NIELS LESNIEWSKI
Republican opposition to legislation to overhaul the U.S. health insurance system grew after Senate Majority Leader Mitch McConnell chose to delay a vote on the measure until after the upcoming Fourth of July recess, a sign of the challenges GOP leadership faces in crafting legislation with support solely from their own party.
Complicating things further, many Republican senators indicated they want a final agreement before they vote on the motion to proceed to the health care reconciliation bill, ensuring that the Senate version would pass largely intact and in the same form before and after the vote-a-rama.
But with Republican senators staking out very disparate positions on the legislation, that will be difficult at best.
Five GOP members previously announced they would vote “no” on a motion to proceed to the legislation. Following McConnell’s decision to delay the vote, however, several more Republican lawmakers announced opposition to the bill that would repeal and replace portions of the 2010 health care law.
“The Senate draft before us includes some promising changes to reduce premiums in the individual insurance market, but I continue to have real concerns about the Medicaid policies in this bill,” Sen. Rob Portman of Ohio said in a joint statement with Sen. Shelley Moore Capito of West Virginia.
“As drafted, this bill will not ensure access to affordable health care in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply, and harms rural health care providers,” Capito said in the statement.
“Repeal involves a significant elimination of the effects of the Affordable Care Act and a replacement with something that is beneficial to Kansans, to Americans in meeting the cost expenses of providing health care to themselves and their families,” Moran said.
He declined to say exactly what his concerns with the current draft are.
Test for leadership
It remains to be seen whether other senators will also come out in opposition to the existing proposal. When asked how many members were prepared to vote against the procedural motion, Senate Majority Whip John Cornyn declined to comment.
“Suffice it to say, we need a little more time,” the Texas Republican told reporters.
Cornyn, who is tasked with determining the vote count on pending legislation, told reporters just hours before McConnell’s announcement that a vote on the procedural motion would be held on Wednesday.
Senate Republican Conference Chairman John Thune said a new draft of the bill could come by the end of the week.
“I would hope by the end of the week that we have reached basically a conclusion with regard to the substance and the policy of this, and then it’s just a function of working out the timing of when we get it to and move it across the floor, which now looks like it will be the week after we get back,” the South Dakota Republican said Tuesday, referring to lawmakers’ return from the upcoming Independence Day recess.
Navigating a growing faction of lawmakers with concerns over the current proposal presents an exceedingly difficult task for McConnell, who remains optimistic a compromise is still possible.
“We will not be on the bill this week, but we’re still working towards getting at least 50 people in a comfortable place,” the Kentucky Republican told reporters after Tuesday’s GOP policy lunch. “We’re continuing to talk about it.”
‘A very delicate balance’
But the decision to delay a vote on the legislation until after the upcoming recess raises questions about whether McConnell will be able to corral the 50 votes needed to advance the bill with a tie-breaking vote from Vice President Mike Pence.
Among the main points of disagreement in the current bill is the rollback of the current law’s Medicaid expansion. Centrist lawmakers have cited the phaseout, which would begin in 2021 and end with a stricter cap on federal funding for the entitlement program in 2025, as a key concern. But any change to that provision, Thune said, would risk alienating conservative lawmakers.
“That’s a very delicate balance, obviously because we have members who fought hard to get that put in there and probably have predicated their vote in favor of this on having a slower rate of growth,” he said Monday.
McConnell should not be counted out. While his margins appear difficult at the moment, an almost parallel version of events played out when the House was trying to pass its own bill to overhaul the 2010 health care law.
Despite facing similar odds, to the point he also pulled a bill from the floor back in March, Speaker Paul D. Ryan was able to muster the votes to pass the legislation after intense negotiations with the conservative House Freedom Caucus. Most of the defections on that bill came from moderates, and bill passed on May 4, 217-213.
McConnell could, for example, put more money for opioid treatment in the bill or allocate more funding to help reduce premiums as a way to bring hesitant lawmakers onboard. But that may not be enough.
“More opioid funding would be very good and very beneficial, but the [problem] for me is the Medicaid provisions,” Capito said.
White House push
In hopes that lightning will strike twice, the White House is ratcheting pressure on the Senate.
After McConnell announced the delay in voting, Republican senators traversed Pennsylvania Avenue on Tuesday afternoon for a huddle with President Donald Trump. Lawmakers returning from that meeting said Trump didn’t impose any pressure on the chamber to act.
“I think it was a good discussion. I think everybody understands what the touch points are,” Sen. Bob Corker, R-Tenn., said.
GOP senators told Trump about their concerns about “[health] market reforms and Medicaid, the future of Medicaid, and Medicaid expansion,” McConnell said.
“Either Republicans will agree and change the status quo or markets will continue to collapse and we’ll have to sit down with [Sen. Charles E. Schumer]. And my suspicion is … any negotiation with Democrats will include none of the reforms that we would like to make on the market side and the Medicaid side. So for all of those reasons, we need to come up with a solution,” he said after lawmakers left the White House.
The meeting comes after an aggressive push by the administration to get senators onboard with the proposal. Several of Trump’s senior aides, including Vice President Mike Pence, Chief of Staff Reince Priebus and Press Secretary Sean Spicer, made the trip to Capitol Hill on Tuesday to speak with members.
The president’s attempts at deal-making also brought him toe-to-toe again with a former GOP presidential primary opponent. Earlier in the day, Trump met with Sen. Rand Paul, an outspoken member who had said he would vote against the motion to proceed to the legislation over concerns that the current draft does not repeal enough of the 2010 health care law.
Paul said he came away from that meeting thinking that the administration would be willing to move the legislation in his direction. He was not so sure, however, about the GOP leadership in the Senate.
“We have a good rapport, and I think he’s open to trying to make the bill better,” the Kentucky Republican said of Trump. “I really haven’t talked to anybody in the Senate leadership, but we’re open to negotiation.”
Paul said the existing Senate measure was already moving in the direction of the more moderate GOP senators.
“The question is, are we going to put some deregulation and some things in there to help the marketplace work that conservatives want,” he said.
McConnell’s close allies in the chamber, including Cornyn and Thune, believe revisions to the current draft can bring hesitant members on board, but some GOP senators were already casting doubt that passage is possible without a full-scale revamp.
“Tweaking isn’t going to work. From my perspective, there would have to be a major overhaul of the bill,” Sen. Susan Collins of Maine said. “Tinkering around the edges is not going to be sufficient to win my support.”
She expressed serious doubts any broad proposal could win the support of herself and more conservative Republicans like Utah’s Lee.
“I never underestimate the creativity of Mitch McConnell, but I can’t see it,” Collins said. “Maybe we do portions of the bill. Maybe we do a bill to stabilize the markets. That might be a narrow bill that would get bipartisan support.”
Lindsey McPherson and John T. Bennett contributed to this report.