Senate GOP leaders faced an increasingly divided caucus on Monday as they push for a vote this week on legislation to replace the Affordable Care Act.
WASHINGTON — Senate GOP leaders faced an increasingly divided and uneasy caucus Monday as they tried to forge ahead with a vote this week on legislation to repeal and replace the Affordable Care Act.
With five Republican senators having announced their opposition to the measure, Majority Leader Mitch McConnell, R-Ky., began the week short of the 51 votes he needs to get the measure through the Senate. Several other GOP senators are lukewarm about the bill and have suggested McConnell is not giving them enough time to assess its impact.
“We need more information, ” Sen. Rob Portman, R-Ohio, said on CNBC’s Squawk Box Monday morning. “Rather than rushing it, we need to get it right.”
On Monday afternoon, the Congressional Budget Office projected the GOP bill would increase the number of uninsured Americans by 22 million over the next decade, compared with current law. The budget office, a nonpartisan agency, also said the bill would reduce the deficit by $321 billion over 10 years.
So far, GOP leaders signaled they would press full-steam ahead — working behind closed doors in the coming days to see whether they can appease the conflicting concerns voiced by moderates and conservatives.
Senate Majority Whip John Cornyn, R-Texas, had previously suggested a vote could roll until the end of July, but he said Monday he was “closing the door” on that notion.
“We need to do it this week before double digit premium increases are announced for next year, ” he tweeted.
Republicans made a few changes to their bill Monday afternoon, with the most substantive addition aimed at individuals who let their insurance lapse for more than two months. Under the Senate GOP plan, they would have to wait for six months before they could restart coverage, an alternative to the unpopular Obamacare requirement that most individuals buy insurance or face a tax penalty.
The newly added GOP provision is designed to encourage people to keep continuous health care — and not just buy it when they get sick. But forcing sick individuals to wait six months before they can get health insurance could be an extremely controversial provision.
“Six months may mean the difference between life and death for a person with cancer awaiting treatment, ” Timothy Jost, a health policy expert, wrote in a Health Affairs blog post on Monday.
Democrats are unified in their opposition to the bill, so McConnell can only afford to lose two Republican votes and still see the measure pass, with Vice President Pence breaking a tie.
Four conservatives have announced their opposition to the bill, saying it does not go far enough in repealing Obamacare’s regulations and consumer protections. Those lawmakers are Sens. Ted Cruz, R-Texas, Rand Paul, R-Ky., Ron Johnson, R-Wis., and Mike Lee, R-Utah.
Johnson said on Monday that he wanted more time to digest the bill and its potential impact, and he suggested he might oppose the GOP leadership’s motion to begin debate.
“I have a hard time believing I’ll have enough information for me to support a motion to proceed this week, ” Johnson told reporters.
Lee is pushing for what he calls an “opt-out” provision, which would allow insurance companies to avoid many of the popular consumer protections included in Obamacare. Lee wants to have that opt-out provision in the bill’s text and not added during the amendment process — where it might not have enough support to pass.
It is not clear Lee will succeed in pushing the bill further to the right. His spokesman Conn Carroll said “discussions are ongoing.”
On the moderate side, Sen. Dean Heller, R-Nev., also came out against the bill, arguing the Medicaid cuts in the bill would hurt low-income residents in his state.
The Republican plan would end the Affordable Care Act’s Medicaid expansion by slowly reducing the enhanced federal funding that covers new enrollees over three years, starting in 2021 and ending in 2024. The ACA expansion allowed states to add more low-income childless adults to Medicaid, with the federal government paying most of the tab.
The GOP bill would also cap the federal contribution to states for the entire Medicaid program — giving states a fixed, per-person allotment. That cap would increase over time, but at a lower rate than medical inflation, meaning the federal dollars would not keep up with health care costs. States would then be faced with cutting the program or covering a huge budget gap to keep the program whole.
“I cannot support a piece of legislation that takes away insurance from tens of millions of Americans and hundreds of thousands of Nevadans, ” Heller said in a news conference on Friday.
Sen. Susan Collins, R-Maine, told ABC This Week on Sunday that “it’s certainly going to be very difficult” for Republicans to come together and support the bill. On Monday, Collins said she was still reviewing the CBO analysis but it was “obviously not positive.”
Collins had already raised a variety of concerns about the draft bill, including higher potential costs for older, sick people and the impact of the Medicaid changes on state budgets.
Collins and Sen. Lisa Murkowski, R-Alaska, also plan to introduce an amendment that would eliminate the bill’s provision that defunds Planned Parenthood for one year.
“I am optimistic we’ ll prevail on that issue, ” Collins said. “It makes absolutely no sense to eliminate federal funding for Planned Parenthood. There already are long-standing restrictions on the use of federal funds for abortion.”
If the Planned Parenthood restrictions are removed, that would make the bill more unpalatable for conservatives like Cruz and Lee.
As Republicans continue to haggle over those crucial and contentious details, Democrats and liberal outside groups are mobilizing an all-out assault on the bill, hoping to derail it.
The liberal group MoveOn.org and allied organizations are planning a “people’s filibuster” outside the Capitol on Tuesday, Wednesday and Thursday. And an interfaith health care coalition plans to lead a 24-hour vigil starting Wednesday afternoon.
“It will be a continuous rolling protest outside the Capitol, ” said Ben Wikler, MoveOn.
