WASHINGTON — Senate Republicans unveiled a new health care bill Thursday that incorporated ideas from conservative senators while giving little to the moderate holdouts in the GOP caucus who were concerned about Medicaid cuts.
A few hours after meeting with the entire Republican caucus to debut the new bill, it looked unlikely that Senate Leader Mitch McConnell, R-Ky., had the votes to even begin to debate on the legislation early next week — his desired timeline. And just minutes before McConnell introduced the legislation to his caucus, two GOP senators unveiled their own alternative bill on CNN, showing just how far off the tracks the Republicans’ health care effort has gone since McConnell first delayed the vote last month.
Unlike the first version, this bill retains some of Obamacare’s taxes on high earners and includes a suggestion from conservative senators that allows insurers to sell stripped-down plans on insurance exchanges. Critics worry that such a measure would lead healthy people to bail on the more comprehensive plans, causing prices to spiral upward for the sick.
Sen. John Cornyn, R-Texas, the majority whip, said he is “confident” the Republicans will have the votes to begin debate on the bill next week. But key senators on both the left and the right remain undecided, which bodes badly for the legislation.
Sen. Rand Paul, R-Ky., said he would not vote to debate the measure, telling reporters he believed it was worse than Obamacare. And Sen. Susan Collins, R-Maine, a moderate, said she could not vote to proceed on the bill because it cuts billions from Medicaid and would leave too many Americans without coverage.
If McConnell loses one more vote on the motion to proceed, he would not be able to bring up the bill to a vote next week. Several more senators, including John McCain, R-Ariz., Lisa Murkowski, R-Alaska, Dean Heller, R-Nev., and Rob Portman, R-Ohio, said they were undecided on the vote Thursday afternoon. Sen. Shelley Moore Capito, R-W.Va., released a statement saying she would wait for a score from the nonpartisan Congressional Budget Office next week before deciding, but remained “concerned” about Medicaid cuts in the bill. Even conservative Sen. Mike Lee, R-Utah, whose suggested change to allow insurers to sell stripped-down plans on exchanges was mostly added into the bill, said he is undecided on whether to proceed on the debate.
President Trump appeared to sympathize with McConnell’s plight, telling reporters aboard Air Force One Wednesday night that getting to 50 votes is “this narrow road that’s about a quarter of an inch wide.”
“I’d say the only thing more difficult than peace between Israel and the Palestinians is health care,” Trump said, according to a transcript.
In the Thursday meeting, McConnell urged his members to vote to allow debate on the bill, reminding them that there will be an open amendment process in which any senator can introduce changes to the bill on the floor. (There is no absolute guarantee the final bill would include those amendments, however, because McConnell will introduce a substitute bill at the very end of the process.)
But it looks likely that McConnell will have to change the bill before that point in order to persuade 50 members of his 52-person caucus to vote to allow debate to begin.
Sen. Mike Rounds, R-S.D., said he believes the measure may be changed to make the Medicaid cuts less drastic. Some moderate senators have objected to the bill’s tying Medicaid funding to the rate of consumer inflation, instead of the higher medical inflation rate.
“Some folks would prefer to have a higher rate of inflation. Right now I think that’s going to be a negotiable item,” Rounds said.
Because the revised legislation retains some of Obamacare’s taxes on higher earners, McConnell has several hundreds of billions of dollars that he can use to win over moderate senators.
“I think we’ve still got resources available to us, and I think there will be continued negotiations among those individuals open to negotiation,” Rounds said.
The bill already includes hundreds of millions of dollars in extra funds for Alaska, which may sway Murkowski, who says she is still undecided. It also earmarks an extra $45 billion for opioid treatment, a priority for Portman and Capito. McConnell may begin doling out money to win over other moderate holdouts, though it remains a tricky balancing act not to lose conservative senators in the process.
Other GOP senators said they were urging their colleagues to vote to allow debate before any more changes are made.
“We can’t change a bill if we’re not on it,” Sen. Marco Rubio, R-Fla., said. “If you have problems with the bill, changes you want to make, you can’t do that if you’re not on the bill.”
But Collins said she believes the legislation is flawed because Republicans crafted it behind closed doors, avoiding the usual committee process that allows Democrats and Republicans to offer amendments and debate the bill in the open before it comes to the floor. The moderate from Maine says she still hopes that process may still come to pass — if the new bill fails next week.
“I don’t see this as the end if this bill were not to pass; I see it as the beginning of the kind of process that I would have liked to have seen in the first place,” Collins said.
Yahoo News reporter Andrew Bahl contributed to this report.