HEALTH CARE LEGISLATION IN JEOPARDY

With 2 defections, GOP lacks votes to move bill forward in Senate.

©2017 New York Times

WASHINGTON — Sens. Mike Lee of Utah and Jerry Moran of Kansas declared Monday night they would oppose the Senate Republican bill to repeal the Affordable Care Act, for now killing a 7-yearold promise to overturn President Barack Obama’s signature domestic achievement.

The announcement by the senators, both Republicans, leaves their leaders two votes short of the necessary tally to begin debate on their bill to dismantle the health law. Two other Republican senators, Rand Paul of Kentucky and Susan Collins of Maine, had already said they would not support a procedural step to begin debate.

“There are serious problems with Obamacare, and my goal remains what it has been for a long time: to repeal and replace it,” Moran said in a statement. He added that the Senate repeal bill “failed to repeal the Affordable Care Act or address health care’s rising costs.”

In his own statement, Lee said of the bill, “In addition to not repealing all of the Obamacare taxes, it doesn’t go far enough in lowering premiums for middle class families; nor does it create enough free space from the most costly Obamacare regulations.”

By jumping together, Moran and Lee ensured no one would be the definitive “no” vote.

With four solid votes against

the bill, Republican leaders were faced with two options: Try to go back and rewrite the bill in a way that could secure 50 Republican votes, a seeming impossibility at this point, or do as Sen. Mitch McConnell, the Republican leader, promised and team with Democrats to draft a narrower, bipartisan measure to fix the flaws in the Affordable Care Act that both parties acknowledge.

The Senate Democratic leader, Chuck Schumer of New York, responded to the announcements by urging his Republican colleagues to begin anew and, this time, to undertake a bipartisan effort.

“This second failure of Trumpcare is proof positive that the core of this bill is unworkable,” Schumer said. “Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long term stability to the markets and improves our health care system.”

The opposition from Paul and Collins was expected, so McConnell had no margin for error as he unveiled the latest version of his bill. Though Paul and Collins rejected his bill, McConnell survived through the weekend and until Monday night without losing another of his members — though some expressed misgivings or, at the very least, uncertainty.

McConnell had wanted to move ahead with a vote this week, but was forced to step back from that plan after Sen. John McCain, R-Ariz., underwent surgery last week. That unexpected setback had given the forces that opposed the bill more time to pressure undecided senators. On Friday, the health insurance lobby, which had been largely silent during the fight, came off the sidelines to blast a key part of the latest Senate bill, saying it was unworkable, would send premiums soaring and would cost millions of Americans their insurance.

McConnell has now failed twice in recent weeks in rolling out his repeal bill and keeping his caucus together in advance of a planned vote. He first wanted to hold a vote in late June, only to abandon that plan after running into opposition.

Lee, one of the most conservative members of the Senate, had championed a proposal that would allow insurers to sell low-cost, stripped-down plans — an idea that ended up being added to the latest version of McConnell’s bill. But the language that was added to the bill was not quite what Lee had been advocating, his office said after the bill was released.

Moran faced pressure in his home state about how the bill would affect Kansas, including its rural hospitals. The Kansas Hospital Association said last week that the latest version of the Senate bill “comes up short, particularly for our most vulnerable patients.”

Senate Republican leaders had returned to the Capitol on Monday still pledging to press ahead with plans to pass the health care overhaul. The day had already begun with uncertainty as McCain’s health created doubts about the legislation’s future.

In a speech on the Senate floor, McConnell said that he spoke with McCain on Monday morning and that “he’ll be back with us soon.” The Arizonan is recovering from surgery to remove a blood clot above his left eye that involved opening his skull.

McConnell had delayed action on health care until McCain’s return.

Sen. Lindsey O. Graham, R-S.C., perhaps McCain’s closest friend in the Senate, spoke to him by phone as he was walking to the Senate chamber for a vote Monday evening. The two had an animated conversation, and Graham said McCain was “dying to get back.”

“They were doing a routine checkup and they found the spot and it looks like everything is going to be A-OK,” Graham said. He said McCain’s doctors “don’t want him to fly for a week, add- ing, “I think he would walk back if they would let him.”

The cause of McCain’s blood clot remained unclear on Monday. The most common causes of clots in the head, especially for older people, are falls, car crashes and other incidents that cause traumas, even minor ones, said Elliott Haut, a trauma surgeon at the Johns Hopkins University School of Medicine. By one estimate, 1.7 million people suffer traumatic head injuries each year, with motor vehicle accidents the leading cause and blood clots that affect the brain a common effect.

Traumas can cause blood to leak out of small vessels in two locations in the head: between the brain and a tough, fibrous layer known as the dura, causing “subdural hematomas,” and between the dura and the skull, causing “epidural hematomas.”

“People die of these every day,” Haut said in an interview, emphasizing that he could not speak about McCain’s health, because he had no details of the case. Blood clots as small as a half-centimeter are worrisome, he said. Epidural hematomas are less often fatal.

Another possibility is that the clot is related to McCain’s history of melanoma, a dangerous form of skin cancer that can spread to other organs, including the brain, and form new tumors. Haut said that is much less likely but not impossible. Diagnosis of a clot in the head requires a CT scan, and it often follows symptoms such as headaches or blurred or changed vision, he said.