Senate’s healthcare plan makes deep cuts
Republicans face further negotiations to sway both moderates and conservatives unhappy with the bill.
WASHINGTON — Get ready for drama-filled days of mock hand-wringing, political jockeying and backroom brinkmanship as the Senate GOP healthcare plan heads toward a hopedfor vote next week.
No sooner did Senate Majority Leader Mitch McConnell unveil the longawaited Obamacare overhaul Thursday than Republican senators started openly negotiating what it would take to win their votes.
Within just a few hours, four key conservative senators — Ted Cruz of Texas, Mike Lee of Utah, Ron Johnson of Wisconsin and Rand Paul of Kentucky — jointly announced they could not possibly vote for the bill as is, unless it more fully guts the Affordable Care Act.
Likewise, centrists withheld their support unless they can push the bill the other way, as they ponder the fallout from leaving millions more Americans uninsured.
Even President Trump — who called the House overhaul bill “mean” — initially withheld his endorsement, suggesting “a little negotiation” would make the Senate version “very good.” Later in the day he tweeted he was “supportive” but looked “forward to making it very special!”
Almost certainly McConnell opened the door to the haranguing by presenting the legislation as a “discussion draft” and inviting input to make it better.
After being widely panned by Democrats and Republicans alike for crafting the bill with unprecedented secrecy, keeping details even from GOP senators, McConnell may now be
GOP SENATE OPPONENTS
At least four Republican senators say they’re opposed to the measure as written — enough to keep it from passing.
THE SENATE GOP PLAN
Some of the key points in the draft of the Senate Republican bill to replace Obamacare:
MEDICAID
The expansion of benefits currently offered under Obamacare would be phased out beginning in 2020 and shut down completely by 2024.
INSURANCE COSTS
A new formula for setting the amount of subsidies would tie them to the cost of less comprehensive health plans. Many consumers would get substantially less assistance than under Obamacare.
INSURANCE MANDATE
The Senate bill eliminates the mandate, and, unlike the House bill, does not include any penalties for people who do not maintain coverage.
GUARANTEED COVERAGE
Unlike the House bill, insurers would not be allowed to charge sick people more. Insurers would be able to charge older consumers five times more than younger consumers.
WOMEN’S HEALTH
States could seek waivers to allow insurers to drop some basic benefits, such as maternity care and contraceptives. Medicaid would be barred from providing funding for any health clinics that offer abortion services, including Planned Parenthood.
eager to convey a sense of open debate and negotiation.
But if the process that played out in the House last month is any guide, expect the deal-making to only go so far before Republicans quickly unify — preferring to hold hands and jump off the political cliff together rather than risk losing their best opportunity to fulfill the Republican promise to stop Obamacare.
“Everybody is offering input right now, and it’s going to be a busy weekend,” said Sen. John Kennedy of Louisiana, who was still considering the legislation. “I don’t know whether it will change or not, but I know a lot of people are in good faith and in earnest about offering additional suggestions, and we’ll probably go right up to the deadline.”
With Republicans holding a slim majority, leaders can only afford to lose support from two GOP senators and still pass the bill in the face of unanimous Democratic opposition.
In many ways, the negotiations will give senators something they have not had during the crafting of the bill behind closed doors: a chance to publicly muscle and maneuver their concerns to the forefront of the debate.
Even if senators are not successful in changing the bill, they will be able to show their constituents that at least they tried.
“This current draft does not have the votes to pass the Senate,” Cruz told reporters.
He is pushing for steeper cuts to Medicaid and fewer requirements related to the essential benefits that insurers must cover.
But Cruz added, “We can get there.”
Voting is expected by the end of next week, a self-imposed deadline as Republicans worry that endless debates over repealing Obamacare would dominate the congressional agenda and leave them — and Trump — with few other legislative acThey complishments.
A delay would also give opponents more time to build up public momentum against the bill, as Democrats and many healthcare groups are already scrambling to do.
Protesters have rallied outside the Capitol and, on Thursday, more than 40 people, including many in wheelchairs, were arrested outside McConnell’s office. warned that the proposed Medicaid cuts threaten to cut off federal money that allows disabled people to live independently.
A week can be a political lifetime in Washington, and few senators are willing to compromise so soon on an issue that has loomed so large over the party.
The risks are clear. If Republicans fail to repeal Obamacare after years of promising to do so, they face the wrath of conservative voters and outside groups.
But if their overhaul leaves millions of Americans without coverage or raises costs, the backlash could be intense.
Polls show that Obamacare’s popularity has soared since repeal efforts began, and Americans largely oppose the House bill.
But even among voters, the politics that have always surrounded Obamacare play a role. According to a June 13 YouGov poll, 56% of Republicans said they supported the House bill. But when compared to keeping Obamacare, 68% said they preferred the House bill.
By banding together as a unified front of opposition, Cruz, Paul and other conservatives are borrowing from a strategy that proved effective for the House Freedom Caucus, which withheld a block of votes to demand changes to the House version.
Just as the conservative caucus opened a direct line of negotiation with the White House, Paul said he had spoken personally to Trump this week about changes the senators wanted to make to the bill.
“We’ll see what kind of olive branch or reaction we get to our comments, and if they’re open to negotiation,” Paul said. “I think we have a chance of negotiating as a team, and it’s much greater than negotiating individually.”
But as the days drag on, McConnell will soon bump into the same problem that confronted Speaker Paul D. Ryan as the House made changes to win conservative votes but ended up chasing away more centrist Republicans.
Senators from Ohio, West Virginia and other states that expanded Medicaid under Obamacare are concerned about cutting constituents off healthcare, particularly as their regions reel from the opiate addiction crisis.
“I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid,” said Sen. Dean Heller, who is perhaps the most endangered Republican up for reelection next year. “If the bill is good for Nevada I’ll vote for it, and if it’s not — I won’t.”
Likewise curtailing funding for clinics and insurance plans that provide abortion services may win conservative support, but it poses a problem for several key Republican women, including Sens. Susan Collins of Maine and Lisa Murkowski of Alaska.
But all the objections and opposition may fade with next week’s deadline for passing the bill before a long Fourth of July holiday recess.
Few senators want to risk being the one responsible for derailing the legislation.
Sen. Tim Scott of South Carolina acknowledged the opposition among his GOP colleagues, but remained optimistic for passage. He was leaning toward voting yes.
“We’re getting there,” Scott said. “Hopefully over the next week we’ll have a chance to just calm their fears and get folks to stay on the team.”
‘I think we have a chance of negotiating as a team, and it’s much greater than negotiating individually.’ — Sen. Rand Paul, one of four conservative senators opposed to the bill