An un­ex­pected de­lay

Post­pone­ment of votes en­er­gizes Repub­li­cans op­posed to leg­is­la­tion

The Washington Post - - FRONT PAGE - BY ELISE VIEBECK elise.viebeck@wash­post.com Sean Sul­li­van, Greg Jaffe and Philip Rucker con­trib­uted to this report.

in plans to hold a vote on the Se­nate health­care bill will strengthen the po­si­tion of con­ser­va­tive crit­ics, ac­cord­ing to Sen. Rand Paul, one of the mea­sure’s out­spo­ken op­po­nents.

Repub­li­can crit­ics of the Se­nate’s lat­est ver­sion of health-care leg­is­la­tion were en­er­gized af­ter lead­ers post­poned votes on the mea­sure, yet an­other sign the bill’s for­tunes are in limbo.

A vo­cal con­ser­va­tive op­po­nent of the mea­sure, Sen. Rand Paul, pre­dicted the de­lay would strengthen crit­ics’ po­si­tion by giv­ing them more time to mo­bi­lize against the bill.

“The longer the bill is out there, the more con­ser­va­tive Repub­li­cans are go­ing to dis­cover it is not re­peal,” Paul (R-Ky.) said Sunday in an in­ter­view with CBS’s “Face the Na­tion.”

Paul said he spoke with President Trump on Fri­day and sug­gested the president sup­port re­peal­ing the Af­ford­able Care Act and de­cid­ing the de­tails of a re­place­ment plan later if the lat­est ver­sion of the bill does not pass.

Trump did not com­ment on health care over the week­end, even as his party faced new chal­lenges in try­ing to ad­vance its lat­est bill. Trump made no ref­er­ence to health care Sunday in an an­gry morn­ing tweet­storm about Hil­lary Clin­ton, the Rus­sia con­tro­versy and other top­ics.

The lack of re­sponse from Trump came af­ter Sen. John McCain (R-Ariz.) an­nounced Satur­day that he is re­cov­er­ing from a surgery and would be ab­sent from votes, de­priv­ing Repub­li­cans of the sup­port they need to ad­vance the leg­is­la­tion. The de­vel­op­ment tem­po­rar­ily dashed McCon­nell’s hopes of wrap­ping up the health-care de­bate by pass­ing a re­worked ver­sion of the Bet­ter Care Rec­on­cil­i­a­tion Act this week.

The bill ex­pe­ri­enced a sep­a­rate blow on Fri­day and Satur­day at a con­fer­ence of gov­er­nors in Providence, R.I., where, de­spite an en­er­getic lob­by­ing cam­paign, Trump ad­min­is­tra­tion of­fi­cials failed to gain sup­port from in­flu­en­tial Repub­li­cans such as Ne­vada Gov. Brian San­doval. Op­po­si­tion from San­doval and oth­ers will make it eas­ier for un­de­cided Repub­li­can se­na­tors from those states to vote no on the bill, po­ten­tially fur­ther en­dan­ger­ing its prospects.

These set­backs are the lat­est in the GOP’s strug­gle to en­act a bill to re­place the Af­ford­able Care Act and ful­fill a cam­paign prom­ise cen­tral to the party’s mes­sage over the past seven years. De­spite uni­fied con­trol of Congress and Trump in the White House, dis­agree­ments within the GOP still threaten to crip­ple its ef­fort to over­haul the health-care sys­tem.

The dif­fi­cult po­lit­i­cal cal­cu­lus fac­ing Repub­li­cans was clear in a new poll re­leased Sunday that showed that the public prefers the Af­ford­able Care Act to the Repub­li­can health-care plan by a roughly 2-to-1 mar­gin. Among Repub­li­cans, 59 per­cent pre­ferred the GOP plan, com­pared with 11 per­cent who pre­ferred the cur­rent law.

The same poll, con­ducted by The Washington Post and ABC News, found that a strong ma­jor­ity (63 per­cent) be­lieves it is more im­por­tant for the gov­ern­ment to pro­vide health cov­er­age to low­in­come peo­ple com­pared with cut­ting taxes (27 per­cent). Among Repub­li­cans, 48 per­cent fa­vored cut­ting taxes, com­pared with 39 per­cent who fa­vored pro­vid­ing health cov­er­age for low-in­come peo­ple.

The bill’s dra­matic cuts to the Med­i­caid pro­gram are a sig­nif­i­cant con­cern for gov­er­nors such as San­doval as well as mod­er­ate se­na­tors such as Su­san Collins (R-Maine).

Vice President Pence and other ad­min­is­tra­tion of­fi­cials sought to al­lay these fears Fri­day and Satur­day by ar­gu­ing that the health-care bill shores up Med­i­caid’s fi­nances to pre­serve the pro­gram for the fu­ture. They also played down the pos­si­ble ef­fects of the cuts.

“President Trump and I be­lieve the Se­nate health-care bill strength­ens and se­cures Med­i­caid for the need­i­est in our so­ci­ety,” Pence said in a speech to gov­er­nors Fri­day. “And this bill puts this vi­tal American pro­gram on a path to long-term sus­tain­abil­ity.”

Collins strongly dis­agreed in an in­ter­view Sunday with CNN.

“You can’t take more than $700 bil­lion out of the Med­i­caid pro­gram and not think that it’s go­ing to have some kind of ef­fect,” she said dur­ing an ap­pear­ance on “State of the Union.”

“This bill im­poses fun­da­men­tal, sweep­ing changes in the Med­i­caid pro­gram, and those in­clude very deep cuts that would af­fect some of the most vul­ner­a­ble peo­ple in our so­ci­ety, in­clud­ing dis­abled chil­dren and poor se­niors,” Collins said. “It would af­fect our ru­ral hos­pi­tals and our nurs­ing homes, and they would have a very hard time even stay­ing in ex­is­tence.”

Pence’s speech was crit­i­cized by Democrats, health-care ad­vo­cates and even some Repub­li­cans for mis­char­ac­ter­iz­ing the pos­si­ble ram­i­fi­ca­tions of the GOP bill.

Dur­ing the same speech, the vice president went af­ter Ohio Gov. John Ka­sich (R), a critic of the leg­is­la­tion, by sug­gest­ing that his state’s ex­pan­sion of Med­i­caid left nearly 60,000 res­i­dents with dis­abil­i­ties “stuck on wait­ing lists, leaving them with­out the care they need for months or even years.”

The claim alien­ated many at the meet­ing, partly be­cause wait­ing lists for Med­i­caid’s home- and com­mu­nity-based ser­vices were not af­fected by the pro­gram’s ex­pan­sion un­der the ACA, and partly be­cause many in­ter­preted Pence’s re­mark as an overly ag­gres­sive shot at Ka­sich. The Ohio gov­er­nor’s stance against the bill could shape the po­si­tion of Sen. Rob Port­man (R-Ohio), a piv­otal vote for Repub­li­cans who is un­de­cided on the cur­rent ver­sion. Some fear Pence missed an op­por­tu­nity to woo Port­man with his re­mark against Ka­sich.

Collins es­ti­mated Sunday that there are eight to 10 Repub­li­can se­na­tors with “se­ri­ous con­cerns” about the bill. “At the end of the day, I don’t know whether it will pass,” she said.

Paul does not be­lieve Se­nate Ma­jor­ity Leader Mitch McCon­nell (R-Ky.) has the votes to pass the leg­is­la­tion, he told Fox. “I don’t think right now [McCon­nell] does,” he said.

The ad­min­is­tra­tion was not in­ter­ested in en­ter­tain­ing analy­ses — in­clud­ing one by con­sult­ing firm Avalere — that show po­ten­tially dev­as­tat­ing con­se­quences for states un­der the GOP bill. At a meet­ing Satur­day morn­ing with gov­er­nors, Health and Hu­man Ser­vices Sec­re­tary Tom Price and Seema Verma, ad­min­is­tra­tor of the Cen­ters for Medi­care and Med­i­caid Ser­vices, worked to un­der­mine that report and a forth­com­ing anal­y­sis by the Con­gres­sional Bud­get Of­fice show­ing the leg­is­la­tion’s cost and in­sur­ance im­pact. This ef­fort bore lit­tle fruit, with San­doval and oth­ers show­ing no signs of be­ing moved by the lob­by­ing ef­fort.

AN­DREW HARRER/BLOOMBERG NEWS

Sen. Rand Paul (R-Ky.) says a de­lay gives crit­ics of the health-care bill more time to mo­bi­lize against it.

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