Brink of defeat

Senate Obamacare repeal on brink of defeat

At least four Republicans could oppose a key procedural vote to call up the bill. And the party remains deeply divided after a CBO report estimating 22 million fewer Americans would have insurance under the plan.

By BURGESS EVERETT and JENNIFER HABERKORN

Senate Republicans’ Obamacare repeal effort is on track to blow up before it even gets started.

The GOP is well short of the votes needed to bring its bill to the floor, and party leaders and President Donald Trump are kicking into overdrive to save their imperiled health care overhaul.

At least four Republican senators, Susan Collins of Maine, Rand Paul of Kentucky, Dean Heller of Nevada and Ron Johnson of Wisconsin, have signaled they could oppose a key procedural vote that will occur either Tuesday afternoon or Wednesday. A number of other senators, like Shelley Moore Capito of West Virginia and Marco Rubio of Florida, are undecided.

Senate Majority Leader Mitch McConnell (R-Ky.) and his team are working furiously to round up 50 of the caucus’s 52 senators to even bring the bill to the floor, let alone pass it by week’s end.

GOP leaders said ultimately that even lawmakers who oppose the bill in its current form could be persuaded to allow the debate over the party’s long-sought Obamacare rollback to begin.

“I would hope … our members would at least let us get on it,” said Sen. John Thune (R-S.D.), the No. 3 GOP leader. “Everybody wants to exert whatever leverage that they can, where they can get the most leverage, but I would expect we’d be able to get on the bill.”

“I think we’re going to be in a good place,” added Senate Majority Whip John Cornyn (R-Texas), the party’s chief vote counter.

Simply overcoming the hurdle is becoming a massive headache for Republican leaders, and the Senate GOP seemed more divided than ever after the release on Monday of the Congressional Budget Office’s analysis.

CBO estimated that 22 million more people will be uninsured over the next decade, but in good news for Republicans, the agency also gave them nearly $200 billion more to spend on the legislation to win over wavering senators with additional federal assistance.

Senators from Medicaid expansion states huddled on Monday evening, hoping to persuade McConnell to pour more money into Medicaid and opioid treatment, but budget hawks are eyeing an opportunity to pocket the savings and decrease the deficit.

“We’re trying to accommodate [senators’] concerns without losing other support,” Cornyn said.

Trump and GOP leadership are doing all they can to tamp down criticism of the legislation and a voting timetable that will provide perhaps just a couple of days for senators to review the final product before a vote.

But those efforts have been complicated by the Trump-linked super PAC America First Policies and its plans to attack Heller and four conservative senators for balking at the bill.

Sources close to McConnell said they were concerned the effort could backfire and jeopardize the entire bill by angering Heller, Johnson, Paul and Sens. Ted Cruz of Texas and Mike Lee of Utah.

“It’s certainly not helpful,” said one of the sources. The second source called the effort “buffoonish.”

The party will meet in a full caucus lunch on Tuesday for a gut check and some senators will dine with Vice President Mike Pence on Tuesday evening.

In the interim, many senators refused to divulge their positions on the bill Monday as the whip effort from McConnell and Cornyn stepped up and the CBO score came down. Sen. Joni Ernst (R-Iowa), a conservative from a Medicaid expansion state, said simply: “I do have an opinion, but I’m not going to share it.”

McConnell worked on wavering senators by phone over the weekend, Republican sources said, and Trump called undecided GOP senators including Cruz, Johnson, Paul and Capito to feel them out on health care, said White House press secretary Sean Spicer on Monday afternoon.

Johnson said in an interview late Monday that he made the argument to Trump that “this bill doesn’t do anything near enough to address the price of premiums.” And the president, Johnson said, was “sympathetic” to his argument.

“I’ve been very upfront with leadership for some time: Don’t jam us, don’t jam the American public,” Johnson said. “I have a hard time believing I’m going to have the information to vote for a motion to proceed.”

The conservative Wisconsinite said McConnell should delay the vote for two weeks and also complained that conservatives’ suggestions to alter the bill in the Senate’s working group were mostly ignored. Similarly, Paul said McConnell and his team are doing little to woo him.

“I had a long conversation with the president last night and I think he’s open to negotiations, but we have not had any word from anyone in Senate leadership,” Paul said in an interview.

The CBO score could complicate things further. In addition to showing large coverage losses, including 15 million fewer insured next year, the agency projects that the Senate bill’s Medicaid changes would result in a 26 percent decline in spending on a program that covers low-income Americans. Obamacare significantly expanded the program.

“I’m not happy with the score,” said Heller, the most vulnerable Senate Republican in 2018.

CBO also projects that insurance premiums would rise over the next year, a major problem for conservatives.

Powerless Senate Democrats, shut out of a process that can circumvent filibusters, seized on the CBO report to slam the bill.

The legislation amounts to a massive redistribution of wealth that “will force millions of Americans to spend more of their paychecks on health care to receive fewer benefits simply so the wealthiest Americans pay less in taxes,” said Senate Minority Leader Chuck Schumer of New York.

Despite some calls by Republicans to delay the vote into next month, most in GOP leadership believe that letting the bill hang out over the Fourth of July recess will result in more “no” votes and slow the GOP’s momentum. The president also suggested that the party could let insurance markets collapse if the bill fails this week.

Republicans say McConnell is ready for the vote to happen, even as they are uncertain about the prospects — eager to move on from the issue one way or another.

“I’m more nervous than I was on Friday. I still think we can solve the problems that a couple of members have brought up,” said Sen. David Perdue (R-Ga.).

Adding to the GOP’s problems, the American Medical Association — the nation’s largest physicians professional group — announced its opposition to the Republican bill Monday because it would violate medicine’s standard to “first, do no harm.”

Republicans did get one nod of approval. Insurance company Anthem said the Senate bill “will markedly improve the stability of the individual market and moderate premium increases” but acknowledged the company is still reviewing the “challenges the current bill proposes” to Medicaid.

Republicans released updated text on Monday intended to promote continuous health coverage, which was left out of the discussion draft released Thursday and is designed to encourage people to buy insurance ahead of an emergency. An additional rewrite is expected shortly before the motion to proceed to the bill, with additional horse-trading expected on the Senate floor, potentially in the form of amendments.

The revised Senate bill would include a six-month “lock out” period in which people who don’t have insurance have to wait before their policy takes effect. The lock out would apply to people who have been uninsured for at least 63 days; people would not have to pay their premiums during that time. The House bill would have allowed insurance companies to charge uninsured people up to 30 percent more for up to one year.

Those provisions represent the GOP alternative to Obamacare’s individual mandate, which is deeply unpopular but helps keep insurance markets afloat.

Because Republicans are keeping the popular requirement that insurance companies accept everyone regardless of pre-existing conditions, which is expensive for insurance companies, the GOP needs some policy to encourage people to buy insurance. Without it, insurance companies would experience a death spiral of too many costs coming in without enough healthy people on the rolls to balance them out.

A White House official said there will be big changes to the bill after the CBO score which will determine “how much can be given to the moderates.” The Senate bill saves $188 billion more than the House bill, which means McConnell has significant leeway to fund senators’ priorities.