Senate Republicans, in the aftermath of a major setback Tuesday, are weighing a swath of changes to legislation to overhaul the U.S. health insurance system, as the rest of their agenda piles up and deadlines near.
The current plan, according to GOP lawmakers, aides and health care lobbyists, is for the conference to try to come to an agreement by Friday on a new draft of the bill to repeal and replace portions of the 2010 health care law. That would give the Congressional Budget Office time to analyze the revisions and let the GOP conference start preparing to vote on the measure when lawmakers return from the July Fourth recess.
But some Republican senators are skeptical of that timeline and have continued to insist there is no strict deadline for action.
“There is certainly a need to move quickly because we have so many other things to do, but there is no absolute end date by which we have to finalize our discussions,” Sen. Michael D. Crapo of Idaho said after a Wednesday GOP lunch. “I hope we do get it done by the August recess.”
Senate Majority Leader Mitch McConnell had hoped to pass the bill out of the chamber by the end of this week, only to delay an initial procedural vote on the measure because he lacked the votes.
There are signs Senate leaders did indeed have a deadline in mind. The Senate Finance Committee, for example, announced Wednesday staff director Chris Campbell was leaving for the Treasury Department. Former Republican aides and lobbyists say the panel had likely planned for his departure to coincide with passage of the bill.
And with health care still in limbo, much of the GOP’s legislative plan is stalled and some Republican members are questioning if leadership even has an agenda in place for the remainder of the year.
“I don’t know what it is,” Arizona Sen. John McCain said. “We have all these issues sitting out there, but we don’t have [any] schedule.”
The chamber’s to-do list remains lengthy. The Senate has yet to take any public steps to craft a fiscal year 2018 budget, has passed no appropriations bills in advance of the Sept. 30 end of the fiscal year, and remains divided on what to do about the debt limit, which the Treasury is close to breaching. Republicans still hope to overhaul the tax code this year, though work on that remains largely behind the scenes.
And McConnell’s decision to forgo the procedural vote this week could make the discussions on the health care overhaul even more difficult. Senators will now have a week in their home states where they are sure to hear from constituents opposed to the measure. Several polls released on Wednesday had public support for the legislation below 20 percent.
Hope springs eternal
Despite that, many Republicans remained hopeful the conference could agree on changes to major provisions in the bill that divide the conference and have stalled the legislation.
But the laundry list of possible revisions under consideration show just how much work GOP leaders face. Among the changes the conference is discussing: a more generous cap on Medicaid funding, allocating money to health savings accounts that individuals can use to pay monthly premiums, additional funding for opioid treatment, and extra resources to help lower-income individuals afford insurance.
Several Republicans, including Sens. Susan Collins of Maine and Mike Rounds of South Dakota, also came out in support of rolling back a repeal of some of the taxes included in the 2010 health care law.
“I think we ought to take a look at the investment tax that’s in the system now and whether or not it would be appropriate to allow that tax to remain so that we can pay for some of these additional costs that have been imposed by Obamacare,” Rounds said.
Lobbyists say McConnell has sent some of these provisions to the CBO to be analyzed, but it remains unclear whether any of the proposals will make it into a revised draft.
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Some members hope to remove language in the bill that would place a stricter cap on the amount of federal funding allocated to the Medicaid program beginning in 2025. But for senators such as Patrick J. Toomey, who fought hard to put the entitlement program on a tighter budget, that could be a nonstarter.
“Consensus is one thing, 50 votes is another thing,” the Pennsylvania Republican said Wednesday, adding that the slower Medicaid growth rate is “very important” to him.
Lawmakers are also considering adding more funding to the bill to improve tax credits that would help lower-income individuals better afford their monthly insurance premium payments, a change that Sen. Bill Cassidy, R-La., said would have the support of President Donald Trump.
“There was a lot of problems, including, most principally,that President Trump had suggested that they add some money back to make it work better and $200 billion more was taken away from credits,” Cassidy said. “The lack of the ability to reconcile that was the root of a lot of dissatisfaction.”
At least nine senators have so far expressed serious concerns with the current proposal, and those members run across both sides of the GOP political spectrum. Three defections would be enough to sink the legislation under the fast-track budget reconciliation procedure that Republicans are using to advance it.
McConnell has nearly $188 billion in available funding above the cost savings in the House bill that he can use to try to persuade hesitant members. Some of his closest confidants in the chamber said that might be the solution.
“These decisions tend to be somebody over here wins and somebody over here loses. In this case, the conservatives have issues they want to address and some of the other more moderate members of our conference have issues they want to address,” Senate Republican Conference Chairman John Thune said.
Mary Ellen McIntire contributed to this report.