Up­root care law, Trump ex­horts

GOP bill for vote is still a mys­tery

Northwest Arkansas Democrat-Gazette - - FRONT PAGE - On the Web Com­pare House, Se­nate bills, Af­ford­able Care Act

WASHINGTON — Pres­i­dent Don­ald Trump brow­beat Repub­li­can op­po­nents of his party’s reel­ing health care bill Mon­day, as­sert­ing that his pre­de­ces­sor’s sig­na­ture over­haul has meant “death” and say­ing the Se­nate’s planned vote is their chance to keep their pledge to re­peal it.

Se­nate Ma­jor­ity Leader Mitch McCon­nell said he’d call a piv­otal vote to­day on be­gin­ning de­bate on the leg­is­la­tion. He said he’s “made a com­mit­ment to the peo­ple I rep­re­sent” to undo Pres­i­dent Barack Obama’s health care over­haul, in what seemed a pointed re­minder to Repub­li­can sen­a­tors that they’ve made the same vow.

McCon­nell, R-Ky., did not de­scribe pre­cisely what ver­sion of the GOP leg­is­la­tion sen­a­tors would be vot­ing on. That omis­sion has caused con­fu­sion and frus­tra­tion among some Repub­li­can sen­a­tors, though oth­ers have said they ex­pect McCon­nell to clar­ify that by the time vot­ing be­gins.

At the White House, Trump lam­basted Democrats who helped en­act the 2010 health care law and now uni­formly op­pose the GOP at­tempt to scrap and re­write it.

“They run out and say, ‘Death, death, death,’” Trump said, with a back­drop of fam­i­lies that he said have en­coun­tered prob­lems get­ting af­ford­able, re­li­able med­i­cal cov­er­age be­cause of Obama’s statute. “Well, Oba­macare is death. That’s the one that’s death.

“Ev­ery Repub­li­can run­ning for of­fice promised im­me­di­ate re­lief from this dis­as­trous law, but so far, Se­nate Repub­li­cans have not done their job in end­ing the Oba­macare night­mare,” the pres­i­dent added.

Trump even jok­ingly threat­ened to fire his health sec­re­tary if the vote fails.

“Hope­fully he’s go­ing to get the votes to­mor­row to start our path to­ward killing this hor­ri­ble thing known as Oba­macare,” Trump said Mon­day at a na­tional gath­er­ing of Boy Scouts in West Vir­ginia, be­fore turn­ing to Tom Price, the sec­re­tary of health and hu­man ser­vices.

“By the way, you go­ing to get the votes? He bet­ter get them,” Trump said, adding, “Oth­er­wise, I’ll say: Tom, you’re fired.”

Trump, who cam­paigned on a prom­ise to im­me­di­ately roll back the health law and en­act a bet­ter sys­tem, said GOP sen­a­tors’ con­stituents would ex­act a price for in­ac­tion — “you’ll see that at the voter booth, be­lieve me” — and hinted that any Repub­li­can who did not sup­port the bid to open de­bate on an as-yet-de­ter­mined health bill would be painted as com­plicit in pre­serv­ing a health law passed on the ba­sis of “a big, fat, ugly lie.”

Some Democrats have said the GOP re­peal ef­fort would lead to death for pa­tients who lose cov­er­age. The non­par­ti­san Con­gres­sional Bud­get Of­fice has said var­i­ous ver­sions of the leg­is­la­tion would mean more than 20 mil­lion Amer­i­cans would be­come unin­sured by 2026.

Trump fo­cused much of his re­marks on GOP sen­a­tors. McCon­nell is nurs­ing a slim 52-48 ma­jor­ity and the pos­si­ble ab­sence of Ari­zona Sen. John McCain, who’s bat­tling can­cer, which would mean two GOP de­fec­tions would sink the mea­sure. McCain’s of­fice an­nounced Mon­day that he would re­turn to Washington to­day.

“For Se­nate Repub­li­cans, this is their chance to keep their prom­ise. Over and over again, they said, ‘Re­peal and re­place, re­peal and re­place.’ But they can now keep their prom­ise,” Trump said.

At least a dozen Repub­li­can sen­a­tors have pub­licly op­posed or crit­i­cized the leg­is­la­tion, more than enough to kill it. That’s forced McCon­nell to step back twice from an­tic­i­pated votes and to re­vise his bill in hopes of mol­li­fy­ing un­happy mod­er­ates and con­ser­va­tives.

McCon­nell’s leg­is­la­tion would up­root much of Obama’s law, elim­i­nat­ing its tax penal­ties on peo­ple not buy­ing poli­cies, cut­ting the Med­i­caid health care pro­gram for the poor and pro­vid­ing less gen­er­ous health care sub­si­dies for con­sumers.

He’s re­vised it once and then said he’d push a vote on leg­is­la­tion sim­ply re­peal­ing Obama’s statute. But McCon­nell and ad­min­is­tra­tion of­fi­cials have also con­sid­ered ad­di­tional changes to the re­peal-and-re­place bill that might at­tract sen­a­tors, leav­ing the fo­cus of to­day’s vote un­cer­tain.

McCon­nell is ex­pected to move ahead with a pro­ce­dural vote to take up the health care bill that nar­rowly passed the House in May. If that vote is ap­proved, the Se­nate would be­gin de­bat­ing a bill to re­peal and re­place the Af­ford­able Care Act.

If McCon­nell can muster 50 votes to be­gin de­bate on the House bill, he could quickly move to re­place it with an en­tirely new bill to re­peal the Af­ford­able Care Act with­out a re­place­ment. If that amend­ment vote fails, he could move to re­place the bill that was passed in the House with a health bill that has been worked out in pri­vate ne­go­ti­a­tions among Repub­li­can sen­a­tors.

None of that would hap­pen if sen­a­tors vote against the mo­tion to pro­ceed.

“It’s still fluid,” said Sen. Pat Roberts of Kansas, who added that he wants to sup­port what­ever plan emerges be­cause he op­poses leav­ing the Af­ford­able Care Act in place.

Com­pli­cat­ing McCon­nell’s task, Ohio GOP Gov. John Ka­sich said it would be a mis­take for the Se­nate to move ahead to­day “and force a one-sided deal that the Amer­i­can peo­ple are clearly against.” Ka­sich’s stance could make it harder for wa­ver­ing Sen. Rob Port­man, R-Ohio, who’s crit­i­cized the mea­sure’s Med­i­caid cuts, to back the leg­is­la­tion.

Yet in one pos­si­ble sign of progress by lead­ers, Port­man said it’s “not as im­por­tant to me” to know what bill McCon­nell would move to if the Se­nate votes to be­gin de­bate.

Ka­sich panned the bill for a lack of “bi­par­ti­san­ship, trans­parency or open di­a­logue.” In a state­ment, the 2016 GOP pres­i­den­tial con­tender said Congress should take no ac­tion on re-craft­ing the na­tion’s health care sys­tem un­til it can “step back from po­lit­i­cal games­man­ship and come to­gether with a work­able, bi­par­ti­san plan.”

Yet Port­man and other un­de­clared Repub­li­can sen­a­tors were also be­ing pounded by the White House.

“Repub­li­cans have a last chance to do the right thing on Re­peal & Re­place af­ter years of talk­ing & cam­paign­ing on it,” Trump tweeted ear­lier Mon­day.

Repub­li­can lead­ers are pres­sur­ing their mem­bers to go along at least with the pro­ce­dural step, to bring them closer to de­liv­er­ing on their long­time prom­ise of re­peal­ing the Af­ford­able Care Act, which was adopted with­out any Repub­li­can votes.

“It’s hard to be­lieve some­body who has run and won elec­tion could go home and face the vot­ers again and say, ‘I’m not even will­ing to de­bate it on the floor,’” Sen. John Bar­rasso of Wy­oming, a mem­ber of the Repub­li­can lead­er­ship, said on CBS’ Face the Na­tion on Sun­day.

Bar­rasso said if the Housep­a­ssed bill makes it to the floor, sen­a­tors could “amend it in var­i­ous ways and lots of mem­bers have dif­fer­ent ideas on how it should be best amended. Un­til the vote is ac­tu­ally on the floor of the Se­nate, some peo­ple may not tell you what they’re ac­tu­ally go­ing to do.”

Rep. Blake Far­en­thold, R-Texas, speak­ing on a Cor­pus Christi, Texas, ra­dio show Mon­day, said it is “ab­so­lutely re­pug­nant” that Repub­li­can sen­a­tors aren’t fol­low­ing through on cam­paign prom­ises to re­peal Obama’s law.

With­out nam­ing them, he men­tioned “fe­male sen­a­tors from the North­east” and said, “If it was a guy from South Texas, I might ask him to step out­side and set­tle this Aaron Burr style,” a ref­er­ence to the firearms duel in which Burr killed Alexan­der Hamil­ton.

Sen. Susan Collins, R-Maine, has op­posed the GOP re­place­ment plan. Other Repub­li­cans ex­press­ing reser­va­tions in­clude Shel­ley Moore Capito of West Vir­ginia and Lisa Murkowski of Alaska.

It will be hard to get peo­ple who have taken hard stands against McCon­nell’s plan or por­tions of it to change their po­si­tions, Roberts said.

“It’s aw­fully dif­fi­cult when peo­ple climb the tree and get out on a limb and say, ‘I’m go­ing to vote no,”’ the Kansas sen­a­tor said. “For them to skinny back down that tree, that’s tough. And they have to have some very good rea­sons as to why that’s the case.”

The re­peal bill is be­ing con­sid­ered un­der spe­cial ex­pe­dited pro­ce­dures that ap­ply to cer­tain bud­get-re­lated leg­is­la­tion. These rules limit de­bate, pre­clude a fil­i­buster and al­low pas­sage with a sim­ple ma­jor­ity vote. How­ever, the rules stip­u­late that pro­vi­sions of the bill can be stricken if they would not change fed­eral spend­ing or rev­enue or if the bud­getary ef­fects are “merely in­ci­den­tal” to some pol­icy ob­jec­tive.

The Se­nate par­lia­men­tar­ian, El­iz­a­beth MacDonough, who serves as a sort of ref­eree, has made a pre­lim­i­nary find­ing that a num­ber of pro­vi­sions of the bill ap­pear to vi­o­late Se­nate rules.

These pro­vi­sions would, for ex­am­ple, cut off fed­eral funds to Planned Par­ent­hood for one year; pro­hibit the use of fed­eral sub­si­dies to buy in­sur­ance that in­cludes cov­er­age for abor­tions; and re­quire peo­ple who have ex­pe­ri­enced a gap in cov­er­age to wait six months be­fore buy­ing in­sur­ance in the in­di­vid­ual mar­ket.

If a sen­a­tor ob­jects to any of these pro­vi­sions, the pre­sid­ing of­fi­cer could sus­tain the ob­jec­tion, fol­low­ing the par­lia­men­tar­ian’s ad­vice. Repub­li­cans would then need 60 votes to keep that pro­vi­sion in the bill, and it would be nearly im­pos­si­ble for them to muster those votes on any sig­nif­i­cant is­sue.

In­for­ma­tion for this ar­ti­cle was con­trib­uted by Alan Fram and Julie Carr Smyth of The As­so­ci­ated Press; Thomas Ka­plan, Julie Hirschfeld Davis, Jen­nifer Stein­hauer and Robert Pear of The New York Times; and Laura Lit­van of Bloomberg News.

AP/ALEX BRAN­DON

Pres­i­dent Don­ald Trump speaks about health care Mon­day in the Blue Room of the White House in Washington.

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