Senate steers toward showdown vote next week on health bill

Sources expect version to provide tax credits linked to income, not age

washington» Senate Republicans steered toward a potential showdown vote on their long-awaited health care bill next week, despite indications that they’ve yet to solidify the 50 GOP votes they’ll need to avert an embarrassing defeat.

Senate Majority Leader Mitch McConnell, R-Ky., said he expected to have a draft of the bill ready Thursday. The measure would peel away much of former President Barack Obama’s health care overhaul and leave government with a more limited role in providing coverage and helping people afford it.

“We have to act, and we are,” McConnell said on the Senate floor.

Later, he simply chortled when asked if he was confident the measure would pass, a victory that would elude him if just three of the 52 GOP senators voted no.

McConnell’s ability to assess and line up votes is considered masterful, and he’s eager to pass legislation fulfilling a keystone campaign promise of President Donald Trump and countless GOP congressional candidates. But underscoring the uncertainty he faces, senators from both ends of his party’s spectrum were grumbling about the bill’s expected contents and the quiet way it’s being crafted.

“It’s apparently being written by a small handful of staffers for members of the Republican leadership,” said conservative Sen. Mike Lee, R-Utah, using a Facebook video for an unusually public swipe at GOP leaders.

Although a member of the 13-senator working group McConnell had tasked with piecing legislation together, Lee said he has not seen the emerging bill and “whole-heartedly” shares the frustration of constituents unhappy over the secrecy. He said senators should have seen the measure “weeks ago” if the chamber is voting next week, the goal of top Republicans.

That echoed Democrats’ lambasting of McConnell for writing the wide-ranging legislation in closeddoor meetings. They unanimously oppose the GOP bill but lack the votes to defeat it. They fear McConnell will jam the legislation through the Senate with little debate, limiting their chance to scrutinize the bill and whip up opposition against it.

“I’ve never heard of a more radical or a more reckless process,” said Minority Leader Chuck Schumer, D-N.Y.

Aides and lobbyists said they expected the GOP bill to provide health care tax credits linked to people’s incomes, not their ages, like the House-passed measure, and impose spending limits on the growth of the federal-state Medicaid program for the poor that would tighten further by the mid2020s. Another possibility was letting states drop some coverage requirements Obama’s law imposes on insurers, they said.

They said unresolved questions included how to make sure the subsidies can’t be used for policies that provide abortions and how fast they can repeal tax boosts Obama levied on high earners and medical companies to finance his statute’s expanded coverage.

The No. 3 Senate GOP leader, John Thune of South Dakota, said Republicans were moving toward phasing out Obama’s enlargement of Medicaid to additional low-income people over five or six years. That might satisfy Republican senators from states that expanded their programs, but conservatives have wanted to halt the extra expenditures quickly.

Although McConnell did not schedule the vote for next week, some Republicans said they believed he would hold it either way. A loss would be a major blow for Trump and congressional Republicans, but it would let GOP senators take a definitive stance on the issue and let Republicans move on to other priorities, such as tax cuts.

“The leadership has made it clear we’re going to vote,” Thune said. “Hopefully we’ll have 50 votes when that time comes.”

At the White House, spokesman Sean Spicer said Trump “clearly wants a bill that has heart.” A week ago, Trump called the version the House approved last month “mean.” Spicer offered no specifics but said Trump wants the Senate to “strengthen it, to make it more affordable, more accessible.”

Besides Lee, two other conservatives were also complaining.

Sen. Ted Cruz, R-Texas, said the Republican plan does “not yet” do enough to reduce premiums, a key GOP goal, and said it needed to go further in easing Obama’s coverage requirements. Sen. Rand Paul, R-Ky., said it would be “a non-starter” if the developing bill’s subsidies are as large as Obama’s.

Moderate Sen. Lisa Murkowski, R-Alaska, said she didn’t know how she’d vote, saying, “What is the deal we have? I have no idea.”

She has opposed conservative efforts to include language barring federal payments to Planned Parenthood.