Repub­li­cans buy time for health­care bill in Se­nate

Ma­jor­ity Leader Mitch McConnell has $200 bil­lion to help sway sev­eral re­luc­tant party mem­bers.

Los Angeles Times - - FRONT PAGE - By Lisa Mas­caro

WASH­ING­TON — The abrupt de­ci­sion Tues­day by Se­nate Ma­jor­ity Leader Mitch McConnell to tem­po­rar­ily shelve a vote on the Repub­li­can Oba­macare over­haul gives him a few ex­tra weeks to build sup­port for a re­vised bill be­fore it risks be­com­ing hope­lessly stalled by the op­po­si­tion.

The sea­soned GOP leader will be aided by what amounts to a $200-bil­lion piggy bank to push Repub­li­cans hold­outs over the line. That’s the bill’s ex­tra sav­ings com­pared with the House ver­sion that McConnell can tap to pro­vide perks to in­di­vid­ual sen­a­tors, from more opi­oid as­sis­tance to ex­panded tax-free health sav­ings ac­counts.

A sim­i­lar strategy — de­lay and en­tice­ments — worked well in the House, where Repub­li­cans last month passed their health­care bill on the third try.

But pro­long­ing the de­bate also gives Democrats and other crit­ics time to mo­bi­lize, and en­sures that sen­a­tors will be ex­posed to an on­slaught of op­po­si­tion as they head home for the week­long hol­i­day break to de­fend a bill es­ti­mated to leave mil­lions more Amer­i­cans with­out in­sur­ance.

After the de­lay was an­nounced, President Trump hosted a White House gath­er­ing of all GOP sen­a­tors. But rather than rally them around the bill with the power of the pres­i­den­tial

bully pul­pit, he struck a sur­pris­ingly de­tached tone.

“This will be great if we get it done,” Trump told sen­a­tors in the East Room. “And if we don’t get it done, it’s just go­ing to be some­thing that we’re not go­ing to like. And that’s OK.”

McConnell was more op­ti­mistic. “Ev­ery­one around the table is in­ter­ested in get­ting to yes,” he said after the meet­ing. “We’ve got a re­ally good chance of get­ting there. It will just take a lit­tle bit longer.”

But fall­out seemed to only grow after the vote post­pone­ment, as sen­a­tors re­al­ized they would have an­other op­por­tu­nity to seek changes and insert their own pri­or­i­ties. As many as 10 Repub­li­can sen­a­tors pub­licly op­pose the bill, though it is likely that sev­eral — par­tic­u­larly con­ser­va­tives seek­ing deeper cuts — will be swayed.

“The Se­nate health­care bill missed the mark for Kansans and there­fore did not have my sup­port,” Sen. Jerry Mo­ran of Kansas, typ­i­cally a re­li­able Repub­li­can vote, said on Twit­ter.

More wor­ri­some for McConnell are GOP cen­trists who say the bill would force painful cuts in Med­i­caid and hurt low- and mod­er­ate-in­come con­sumers in­sured un­der the Af­ford­able Care Act.

Sens. Shel­ley Moore Capito of West Vir­ginia and Rob Port­man of Ohio, whose states are heav­ily re­liant on Med­i­caid, es­pe­cially for ad­dic­tion ser­vices, jointly an­nounced their op­po­si­tion as they seek re­vi­sions.

“This bill will not en­sure ac­cess to af­ford­able health care in West Vir­ginia,” Capito said in a state­ment. “My con­cerns will need to be ad­dressed go­ing for­ward.”

Among the most skep­ti­cal is Sen. Su­san Collins (RMaine), a mod­er­ate who ques­tioned whether re­vi­sions would even make a dif­fer­ence to her.

“It’s dif­fi­cult to see how any tin­ker­ing is go­ing to sat­isfy my fun­da­men­tal and deep con­cerns about the bill,” Collins told re­porters Tues­day.

With just a 52-seat ma­jor­ity and a wall of Demo­cratic op­po­si­tion, McConnell can af­ford to lose only two Repub­li­can votes.

His prob­lems are not in­sur­mount­able, though. The Se­nate leader faces the same po­lit­i­cal dy­namic that tripped up House Speaker Paul D. Ryan last month as con­ser­va­tives pressed to fully gut Oba­macare, while cen­trists, es­pe­cially in states that have ex­panded Med­i­caid, tried to pre­serve the pro­gram’s gains in vastly re­duc­ing the num­ber of unin­sured Amer­i­cans.

But the Ken­tuck­ian has the ben­e­fit of $200 bil­lion in ad­di­tional sav­ings in the Se­nate draft, and law­mak­ers are al­ready lin­ing up for their share.

For ex­am­ple, sen­a­tors from states reel­ing from the opi­oid cri­sis are seek­ing an ad­di­tional $45 bil­lion for ad­dic­tion ser­vices, while con­ser­va­tives need about $60 bil­lion for their pro­vi­sion ex­pand­ing tax-free health sav­ings ac­counts.

Now the ques­tion is not just whether Repub­li­cans can amass the sup­port to pass the bill amid their own party di­vi­sions, but whether they want to take on the po­lit­i­cal bag­gage of a health­care cri­sis that has been mainly car­ried by Democrats un­til now.

“I hate this,” said one Repub­li­can se­na­tor.

A non­par­ti­san Con­gres­sional Bud­get Of­fice re­port says 15 mil­lion more Amer­i­cans would be with­out in­sur­ance in the first year of the bill’s pas­sage, swelling to 22 mil­lion over a decade and wip­ing out the Af­ford­able Care Act’s cov­er­age gains.

Busi­ness groups that typ­i­cally align with Repub­li­cans, in­clud­ing the Cham­ber of Com­merce, urged pas­sage.

But Repub­li­can sen­a­tors have been sub­jected to with­er­ing crit­i­cism from pa­tient ad­vo­cates, physi­cians’ groups, nurses and hos­pi­tals, which are all warn­ing about the dev­as­tat­ing con­se­quences of the health­care leg­is­la­tion.

Not a sin­gle group rep­re­sent­ing pa­tients, physi­cians or nurses sup­ports the GOP mea­sure.

Polling shows scant sup­port for the Repub­li­can ap­proach to health­care, based on sur­veys on the Housep­a­ssed bill, even though sup­port for re­peal­ing Oba­macare re­mains high among GOP vot­ers.

“There are so many peo­ple, mil­lions of peo­ple, who would be harmed by this bill,” said Se­nate Mi­nor­ity Leader Charles E. Schumer of New York, as Democrats gath­ered on the Capi­tol steps hold­ing poster-sized pho­tos of con­stituents who rely on Oba­macare.

“This is not just ab­stract num­bers. Th­ese are real peo­ple,” Schumer said. “This is who we’re fight­ing for.”

At its core, the Se­nate bill, like its com­pan­ion in the House, does not fully re­peal Af­ford­able Care Act. In­stead, it ends the Oba­macare man­date that all Amer­i­cans must carry in­sur­ance and cuts nearly $550 bil­lion in taxes that were im­posed on the health­care in­dus­try and high-in­come Amer­i­cans to pay for ex­pand­ing Med­i­caid cov­er­age and pro­vid­ing sub­si­dies for private in­sur­ance.

The re­sult, ac­cord­ing to an anal­y­sis from the Tax Pol­icy Cen­ter, is a big tax break for the wealth­i­est Amer­i­cans. The top 1% of house­holds, those earn­ing more than $875,000 a year, would aver­age a $45,000 tax break, the cen­ter said. Those earn­ing be­yond $5 mil­lion would get a break of about $250,000. Mean­while, mid­dle-in­come fam­i­lies earn­ing be­tween $55,000 and $93,000 would see a $280 tax cut.

Trump’s role may ex­pand, es­pe­cially as con­ser­va­tive sen­a­tors take their con­cerns di­rectly to the White House. Sen. Rand Paul (R-Ky.) said he had a “very warm” meet­ing Tues­day to share ideas with Trump.

Paul is among sev­eral con­ser­va­tive sen­a­tors push­ing for changes, one be­ing a pro­vi­sion to let in­sur­ers of­fer low-cost, bare-bones poli­cies along­side those that meet the Af­ford­able Care Act’s stricter re­quire­ments.

The in­ter­nal strife over the bill is tak­ing a toll on the Repub­li­can Party. Trump al­lies in the Amer­ica First Poli­cies PAC stunned sen­a­tors by tar­get­ing Sen. Dean Heller of Ne­vada — per­haps the most en­dan­gered GOP se­na­tor up for re­elec­tion in 2018 — with an ad urg­ing him to vote for the bill. He has voiced doubts.

After GOP sen­a­tors com­plained about the ads to Trump on Tues­day, the group an­nounced it was pulling them.

One wealthy Repub­li­can donor, Texan Doug Dea­son, told re­porters at the con­ser­va­tive Koch net­work’s meet­ing last week­end that he had in­formed House Repub­li­cans he would with­hold cam­paign do­na­tions un­til they get be­hind Trump’s agenda — and pass an Oba­macare re­peal.

Democrats are ea­ger to keep up the pres­sure on Heller and other Repub­li­cans who have ex­pressed mis­giv­ings about the bill, sad­dling them with Trump’s own as­sess­ment of the Repub­li­can ap­proach as “mean.”

Sen. Richard J. Durbin (D-Ill.) ques­tioned whether Trump would en­gage be­yond the ral­ly­ing he did to get re­luc­tant House Repub­li­cans on board and then re­ward them for pas­sage with a Rose Gar­den cel­e­bra­tion.

“I’m not sure what his role’s go­ing to be in this,” Durbin said Tues­day. “When it comes down to it, he had a keg­ger party to cel­e­brate a House bill, which two weeks later he called a ‘mean’ bill.”

Su­san Walsh As­so­ci­ated Press

“IF WE DON’T get it done, it’s just go­ing to be some­thing that we’re not go­ing to like,” President Trump told GOP sen­a­tors. Maine’s Su­san Collins, left, says she has “fun­da­men­tal and deep con­cerns about the bill.”

Saul Loeb AFP/Getty Images

“THIS IS NOT just ab­stract num­bers .... This is who we’re fight­ing for,” said Se­nate Mi­nor­ity Leader Charles E. Schumer, sec­ond from right, as Democrats dis­played posters of con­stituents who de­pend on Oba­macare.

Alex Bran­don As­so­ci­ated Press

SE­NATE MA­JOR­ITY Leader Mitch McConnell, right, is caught be­tween con­ser­va­tives who want to gut Oba­macare and cen­trists who want to keep some parts.

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