Health care bill heads for cliffhanger vote

Ryan breaks GOP tensions with suggestion of possible House-Senate conference

WASHINGTON — Senate Republicans headed for a cliffhanger vote early Friday on their scaled-back plan to overhaul the Affordable Care Act following assurances from House Republican leaders that they were willing to use the proposal as a basis for negotiating a broader rollback of the law.

After a two-hour standoff, House Speaker Paul Ryan, R-Wis., issued a measured statement expressing openness to a House-Senate conference that many rank-and-file Republican senators have demanded as a condition for backing the “skinny repeal” legislation that has little substantive appeal to them.

Ryan’s statement was followed by Senate Majority Leader Mitch McConnell unveiling the new proposal, a more narrow rewrite of the health law Democrats passed in 2010, followed by a marathon session of votes on health-care amendments that would last overnight and well into Friday morning.

“If moving forward requires a conference committee, that is something the House is willing to do,” said Ryan, who scheduled a pivotal meeting with his House caucus Friday to hash out the Senate’s demands. “The House remains committed to finding a solution and working with our Senate colleagues, but the burden remains on the Senate to demonstrate that it is capable of passing something that keeps our promise.”

Although Ryan eased some tensions, it remained to be seen whether it will be enough to win over a bloc of Senate Republicans who earlier had declared the proposal “terrible.”

“I would like to have the kind of assurances he didn’t provide,” Sen. John McCain, R-Ariz., told reporters.

Sen. Lindsey Graham, R-S.C., later indicated he had been sufficiently swayed to support the new plan.

Earlier, McCain, Graham and Sen. Ron Johnson, R-Wis., convened a news conference as part of an extraordinary spectacle that highlighted the extent to which Republicans are struggling to reconcile their desire to tear down President Barack Obama’s landmark 2010 law with their inability to unite behind a replacement.

Republicans have been promising for seven years to repeal the Affordable Care Act (ACA) but never had a Republican in the White House to carry out their demands - until President Trump began urging lawmakers via speeches and tweets to send him something to sign.

Translating that pledge into a new law has proven to be embarrassingly difficult for Republicans. First, Ryan had to take an extra six weeks for the House to pass its version of the bill, in early May. Most Republicans agreed that bill was flawed - Trump later called it “mean” for how it would deny insurance to 23 million people - and hoped that the Senate would craft a better bill.

But McConnell’s closed-door negotiations ended in gridlock, leaving him to pull together this “skinny” repeal of the ACA, just to keep alive negotiations with the House to come up with a different plan later this summer.

It would eliminate enforcement of the Affordable Care Act’s requirement that Americans obtain coverage or pay a tax penalty, and suspend for eight years enforcing the mandate that firms employing 50 or more workers provide insurance.