Health bill’s support sagging

Senators say they’d like more time to study, debate; CBO analysis due later this week

Senate Republicans are facing an increasingly daunting challenge to secure the votes necessary to pass legislation to dramatically change President Barack Obama’s signature health-care law, and several senators said they would like more time to debate and tweak the plan as GOP leaders push for a vote this week.

At least five Republicans have already come out against their party’s bill — which can afford to lose only two votes — and over the weekend, more began expressing serious reservations and skepticism about the proposal.

The mounting dissatisfaction leaves Senate Republican leaders and the White House in a difficult position. In the coming days, moves to narrow the scope of the overhaul could appeal to moderates but anger conservatives, who believe the legislation does not go far enough to repeal and replace the Affordable Care Act, known as “Obamacare.”

A key moment will arrive early this week when the Congressional Budget Office releases an analysis of the bill that estimates how many people could lose coverage under the Republican plan, as well

“It’s hard for me to see the bill passing this week.” — Susan Collins. R-Maine “Give me 90 percent repeal, I’d probably vote for it.” — Rand Paul, R-Kentucky

as what impact it might have on insurance premiums and how much money it could save the government.

The stalled Republican effort to pass a sweeping rewrite of the Affordable Care Act was further threatened Sunday when Republican senators from opposite sides of the party’s ideological spectrum voiced their disapproval, imperiling hopes for a Senate vote this week and President Trump’s chance to fulfill a core campaign pledge.

Sen. Susan Collins, RMaine, on Sunday expressed deep concerns about how the bill would cut expanded Medicaid funding for states, a key pillar of the Affordable Care Act that several centrists in the Senate are wary of rolling back, saying on ABC’s “This Week” that she worries about “what it means to our most vulnerable citizens.”

Collins also said she is concerned about the bill’s impact on the cost of insurance premiums and deductibles, especially for older Americans.

“I’m going to look at the whole bill before making a decision,” she said, later adding, “It’s hard for me to see the bill passing this week.”

Underscoring the challenge facing Senate Majority Leader Mitch McConnell, R-Ky., Sen. Rand Paul R-Ky., speaking on the same Sunday show, also voiced concerns with the bill — but for entirely different reasons.

Paul — who, along with fellow Republican Sens. Ted Cruz of Texas, Ron Johnson of Wisconsin and Mike Lee of Utah, has already said he cannot support the current bill — rejected the Republican plan as not fiscally austere enough but said that in the face of an impasse, he could support legislation that simply repeals Obama’s health care law.

“I’ve been telling leadership for months now I’ll vote for a repeal,” Paul said. “And it doesn’t have to be a 100 percent repeal. So, for example, I’m for 100 percent repeal, that’s what I want. But if you give me 90 percent repeal, I’d probably vote for it. I might vote for 80 percent repeal.”

But simply repealing Obamacare or large parts of the law without making any other changes to the nation’s health care system is not a realistic political possibility at the moment.

Vote must come soon

McConnell and his team remain convinced they must call a vote soon to avoid having health care discussions dominate the summer, when they aim to move on to retooling tax legislation. In their circle, further talks are also seen as an opening for others to bolt.

“It’s not going to get any easier,” Senate Majority Whip John Cornyn, RTexas, told reporters on the sidelines of a threeday seminar organized by billionaire industrialist Charles Koch in Colorado Springs. “And, yes, I think August is the drop deadline, about Aug. 1.”

As senators took to the airwaves Sunday, there were developments behind the scenes as GOP leaders made calls and worked to cobble together votes. But no firm decisions on votewinning revisions were made.

There was new talk among key GOP figures about wooing moderates by altering the bill’s Medicaid changes, according to two people involved who would not speak publicly. By tweaking how federal funding is determined for Medicaid recipients and linking aspects to the medical component of the consumer price index, there is a belief that some moderates could be swayed, since they want assurances that funding would keep up with any rises in the cost of care, the people said.

Then would come the tightrope: If some senators can be persuaded to support revisions to the Medicaid portion of the bill, several conservatives are warning that unless their amendments are also included, they are unlikely to support the legislation. The hope is that a combination of those Medicaid changes and amendments from conservatives could pave the way to passage.

July Fourth deadline

Progress in these conversations could postpone a vote for a couple of weeks until after the Fourth of July holiday, the people said, but Senate leadership and the White House want to move this week if they can.

The administration itself, meanwhile, is sending mixed signals. An allied leadership PAC is launching an intensive advertising campaign against centrist Sen. Dean Heller, R-Nev., a no vote, to pressure him to support the bill. And on CNN’s “State of the Union,” Kellyanne Conway, counselor to the president, said Trump “is working the phones, he’s having personal meetings, and he’s engaging with leaders.”

Conway added that “the president and the White House are also open to getting Democratic votes,” and asked, “Why can’t we get a single Democrat to come to the table, to come to the White House, to speak to the president or anyone else about trying to improve a system that has not worked for everyone?”

But Democratic support seems unlikely. Senate Minority Leader Charles E. Schumer, D-N.Y., speaking on “This Week,” said Democrats would only sit down with Republicans if they stop trying to repeal Obamacare. In an interview with The Washington Post, Sen. Bernie Sanders, I-Vt., spoke of trying to postpone a vote on the bill to mount a stronger fight against it.

“One of the strategies is to just keep offering amendments, to delay this thing and delay this thing at least until after the July Fourth break,” Sanders said. “That would give us the opportunity to rally the American people in opposition to it. I think we should use every tactic that we can to delay this thing.”