Rac­ing the clock on health­care

Repub­li­cans feel­ing pres­sure on re­peal and re­place — not to men­tion on the rest of Trump’s agenda.

Los Angeles Times - - THE NATION - By Lisa Mas­caro and Noam N. Levey lisa.mas­caro@la­times.com noam.levey@la­times.com

WASH­ING­TON — Pres­i­dent Trump sum­moned Re­pub­li­can lead­ers to the White House on Tues­day to dis­cuss his sum­mer leg­isla­tive agenda, but progress is be­ing stalled by the GOP’s in­abil­ity to ful­fill its prom­ise to re­peal and re­place Oba­macare.

Lack­ing con­sen­sus over how to gut the Af­ford­able Care Act without leav­ing mil­lions more Amer­i­cans unin­sured — as the House GOP’s bill would do — Se­nate Repub­li­cans face a log­jam that could im­peril other priorities, such as tax re­form and in­fra­struc­ture.

This week was ex­pected to be piv­otal for the over­haul, which law­mak­ers hope to fin­ish be­fore the July 4 break in or­der to move to other is­sues like rais­ing the debt ceil­ing to avoid de­fault­ing on the na­tion’s bills.

But sen­a­tors emerged from closed-door meet­ings Tues­day no closer to an agree­ment than they have been af­ter weeks of talks.

“The ar­eas we have con­sen­sus on? Let’s see, Oba­macare sucks,” said Sen. John Kennedy (R-La.). “We may be work­ing on this for a while.”

That echoed re­cent com­ments from Se­nate Ma­jor­ity Leader Mitch McCon­nell and oth­ers. Some spec­u­late lead­ers may be tempted to call a Se­nate vote on the bill even if they know it will fail, sim­ply to move the is­sue off their plate for now.

Trump em­pha­sized the im­por­tance of a health­care vote in a talk with House Speaker Paul D. Ryan, McCon­nell and other lead­ers. “At the core of this agenda is re­peal­ing and re­plac­ing the dis­as­ter known as Oba­macare,” said Trump, who dined later Tues­day with House and Se­nate Repub­li­cans. He praised the House bill as a good first step. “Now the Se­nate, I’m sure, will fol­low suit and get a bill across the fin­ish line this sum­mer.”

But the GOP is star­ing down a cal­en­dar with lit­tle to show for its hold on the House, Se­nate and White House. Usu­ally the first six months of a pres­i­dency — espe­cially with a Congress con­trolled by the same party — are prime time for leg­is­lat­ing be­fore the midterm cam­paign.

But this year is an ex­cep­tion, thanks in part to Trump’s un­usual lead­er­ship style and the in­quiry into his cam­paign’s po­ten­tial ties with Rus­sia in the 2016 elec­tion. His shift­ing po­si­tions have Ryan and McCon­nell strug­gling to lead the party in a co­her­ent strat­egy.

The White House ac­knowl­edged that the Rus­sia in­ves­ti­ga­tion had taken a toll. Ques­tions swirl al­most daily with de­vel­op­ments on Capi­tol Hill, and more are ex­pected this week when fired FBI Di­rec­tor James B. Comey tes­ti­fies be­fore the Se­nate In­tel­li­gence Com­mit­tee.

“There’s no doubt that keep­ing mem­bers fo­cused on in­ves­ti­ga­tions de­tracts from our leg­isla­tive agenda and de­tracts from what we’re try­ing to de­liver,” Marc Short, White House leg­isla­tive di­rec­tor, said in a call with re­porters this week.

The crux of the stale­mate is the GOP’s in­abil­ity to de­liver on its health­care vow. Though Ryan ush­ered the House GOP’s health­care bill through in May, Se­nate Repub­li­cans dis­missed it, in part be­cause it could leave 23 mil­lion more Amer­i­cans without in­surance.

In try­ing to build their own bill, McCon­nell has jet­ti­soned the tra­di­tional process of com­mit­tee hear­ings and ex­pert tes­ti­mony in fa­vor of closed-door meet­ings among key sen­a­tors.

Some, in­clud­ing Sen. Ted Cruz of Texas, praise this strat­egy. “One of the most en­cour­ag­ing as­pects of th­ese dis­cus­sions is they have not been lit­i­gated in the press,” he told re­porters Tues­day.

But oth­ers say a more open process, in­clud­ing one that doesn’t rely on a pro­ce­dural ma­neu­ver that will al­low sim­ple ma­jor­ity pas­sage without any need to build bi­par­ti­san con­sen­sus with Demo­cratic votes, would have been more pro­duc­tive.

“This is a re­ally big mess, and a very com­plex sys­tem, and so you don’t do that in a cou­ple of weeks,” said Sen. Ron Johnson (R-Wis.), who ex­pects his party will need a stop­gap mea­sure to sta­bi­lize in­surance mar­kets while they work on a broader over­haul.

Se­nate Repub­li­cans face a se­ries of dif­fi­cult de­ci­sions, in­clud­ing how to pro­tect older, sicker and lower-in­come con­sumers who would see huge in­surance pre­mium hikes un­der the House bill.

But no is­sue has proved more chal­leng­ing than Med­i­caid, the 52-year-old plan for the poor that is a pil­lar of Oba­macare’s cover­age ex­pan­sion.

While many Repub­li­cans have long pledged to cut Med­i­caid, they are now re­luc­tant to undo the pro­gram that pro­vides cover­age to more than 70 mil­lion low-in­come Amer­i­cans.

The House bill would slash more than $800 bil­lion in fed­eral Med­i­caid spend­ing in the next decade, rolling back the ex­pan­sion and cap­ping fu­ture aid to states.

But those cuts — de­cried by ma­jor physi­cian and pa­tient groups — make some key GOP sen­a­tors un­com­fort­able, in­clud­ing law­mak­ers from states that have ex­panded Med­i­caid, such as Ne­vada and Ari­zona.

Sen. John Bar­rasso (RWyo.) said sen­a­tors were con­sid­er­ing tak­ing longer to cut Med­i­caid than the House bill, de­lay­ing re­duc­tions un­til af­ter 2020 — and the next pres­i­den­tial elec­tion.

If McCon­nell can­not bridge the Med­i­caid di­vide, he may have to re­fo­cus ef­forts on lim­ited leg­is­la­tion to res­cue in­surance mar­kets that have been bat­tered by the po­lit­i­cal tur­moil.

A grow­ing num­ber of in­sur­ers are leav­ing Oba­macare mar­kets or propos­ing steep pre­mium in­creases, partly be­cause of the law’s weak­nesses but also be­cause the Trump ad­min­is­tra­tion re­fuses to com­mit to steps to keep them op­er­at­ing, such as en­forc­ing a penalty on peo­ple who don’t get in­surance and pro­vid­ing aid to low-in­come con­sumers.

That is be­com­ing a grow­ing prob­lem for Re­pub­li­can law­mak­ers, as polls in­di­cate Amer­i­cans in­creas­ingly hold the GOP re­spon­si­ble for in­surance mar­kets’ fate.

House Mi­nor­ity Leader Nancy Pelosi said Tues­day that Trump was “sab­o­tag­ing” the health­care law.

“The Af­ford­able Care Act is the law of the land,” Pelosi said on CNN. “The pres­i­dent should be hon­or­ing the law of the land and fund­ing it…. If the rates go up, that’s at his doorstep.”

Pablo Martinez Monsivais Associated Press

SE­NATE MA­JOR­ITY LEADER Mitch McCon­nell of Ken­tucky, left, and Pres­i­dent Trump take their seats as GOP con­gres­sional lead­ers meet at the White House to dis­cuss the pres­i­dent’s leg­isla­tive agenda.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.