Senate GOP Delays Health Vote in Search for Support

Senate GOP Delays Health Vote in Search for Support
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Nearly seven years into the GOP effort to replace Obamacare, Senate Republicans and President Trump openly entertained the possibility Tuesday that a health care bill still lacking sufficient support -- which forced them to delay a crucial vote -- won’t be in any better shape after a few more weeks of internal deliberations.

The deep divisions within Washington’s ruling party frustrated lawmakers who voted more than 60 times prior to Trump’s election to repeal the Patient Protection and Affordable Care Act, but now concede that any replacement remains a legislative and political puzzle. For every conservative who favors trimming benefits and ending Medicaid’s expansion, there are moderates who refuse to follow suit. And when the president argues that Obamacare is effectively “dead,” families in state after state buttonhole their lawmakers at town-hall meetings to say the imperfect law is saving lives.

Mired in legislative deadlock and eyeing the 2018 midterm contests, Republican lawmakers fear they are risking the support of their base while pumping oxygen into the Democrats’ electoral chances. Trump frets that his first year will end up devoid of big legislative victories.  The prospects of a tax reform bill — linked to health care through budgetary rules — dimmed Tuesday along with any ACA replacement.

Facing a potentially enormous failure with more than half a dozen senators opposing the Senate bill in its current form, Majority Leader Mitch McConnell delayed voting on the measure Tuesday in favor of continued negotiations and, if they can strike a deal, a vote in July. Lawmakers will be back in their home states next week for the Fourth of July holiday.  

Several senators came out opposed to the bill after the delay was announced, indicating the opposition among Republicans was deeper than just those who had already declared their position publicly.

Trump invited the entire Senate GOP conference to the White House shortly after the delay was announced for a large roundtable discussion about the legislation’s prospects. Symbolically, the president sat next to Susan Collins of Maine and Lisa Murkowski of Alaska, who have expressed serious concerns about the measure. On the other side of Collins was Dean Heller of Nevada, who announced his opposition to the draft legislation last week.

Trump told the senators they were “getting very close” and “have to have health care,” but also hinted at the possibility of not passing a bill.

“This will be great if we get it done,” he said. “And if we don’t get it done, it’s just going to be something that we’re not going to like. And that’s okay, and I understand that very well.”

After the meeting, most senators avoided speaking to the press when their bus returned to Capitol Hill. John Thune, a member of GOP leadership, said the president had a “good flavor” for the key differences on the legislation, but wasn’t necessarily pushing specific changes.

“He kind of knows what the high points of the discussion are and I just think he wants to see us come together around a solution,” Thune said.

The precarious politics of the legislation were part of the discussion as well. Thune said Heller brought up the ads being run against him by a pro-Trump super PAC. McConnell voiced his displeasure about the spots to White House Chief of Staff Reince Priebus, according to the New York Times, and the group pulled the ads Tuesday evening.

McConnell, for his part, was calm about delaying the vote Tuesday, telling reporters that they would continue to address the differences within the conference in trying to patch together enough support to pass the measure.

“It’s an ongoing discussion,” McConnell said, adding that several senators wanted more time to evaluate the bill. “We have a number of different discussions going on. They have been going on for six weeks now and they continue. This is a big, complicated subject.”

Most Republican senators appeared relieved and grateful that the vote was delayed, including many who had publicly complained about leadership rushing the process. But senators will now spend more than a week back in their states, hearing from constituents on the details of the legislation, which has polled as highly unpopular. Some Republicans had expressed concern that letting the legislation linger over the holiday would make it more difficult to pass.

The reality for McConnell is that he has a difficult puzzle to piece together: Nearly half a dozen conservatives have objected to the bill because, they argue, it doesn’t do enough to lower health care premiums. They have pushed to allow insurers to offer plans that don’t comply with Affordable Care Act regulations, or to repeal the regulations entirely, to achieve that goal. Sens. Rand Paul, Mike Lee, Ted Cruz and Ron Johnson announced opposition last week, and have said this week that few of their concerns have been dealt with in negotiations.

“The first draft of the bill included hundreds of billions of dollars in tax cuts for the affluent, bailouts for insurance companies, and subsidies for lower-income Americans,” Lee said in a statement Tuesday. “But it ignored the middle-class families who have borne the brunt of Obamacare, and who have been left behind by both parties in Washington for too long.”

On the moderate side, nearly as many senators are concerned about a rollback of the Medicaid expansion under the Affordable Care Act, deep cuts to Medicaid spending compared to current projections, and Congressional Budget Office projections that as many as 22 million fewer Americans would have insurance over the next decade if the bill were enacted. Heller and Collins have been opposed to the legislation since its unveiling, and Sens. Jerry Moran of Kansas, Shelly Moore Capito of West Virginia and Rob Portman of Ohio announced after the vote was pushed back that they also oppose it.

Portman said he has some “real concerns” about Medicaid policies, specifically those that impact substance abuse, and said the legislation “falls short.” Capito, who told reporters she is concerned about inadequate funding to address the opioid epidemic, said Medicaid funding was her main concern. She said in a statement that the measure is “not the right fix for West Virginia.”

“This bill will not ensure access to affordable health care in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts Medicaid too deeply and harms rural health care providers,” Capito said in a statement.

Assuaging those separate issues, plus dealing with other senators who have not yet publicly taken a position, has proven a difficult task to this point.

“Every time you get one bullfrog back in the wheelbarrow, another one jumps out,” Sen. John Cornyn, a member of leadership and a top McConnell ally, told reporters. “I don’t think there is a silver bullet except the attitude that we’re trying to get to yes.”

After the meeting, senators said the goal McConnell presented was to negotiate changes by the end of this week, when lawmakers depart for their weeklong break. They expect to receive an updated score from the Congressional Budget Office during that time, and hope to vote on the measure when they return to Washington.

The House went through similar machinations when it debated health care earlier this year, originally pulling a vote minutes before it was scheduled because it lacked sufficient Republican support, then ultimately negotiating an agreement that brought enough members on board to pass it by a narrow margin. Senate Republicans now face that precise scenario.

Much is on the line for the GOP lawmakers, all of whom won elections in the previous seven years running on promises to repeal and replace President Obama’s signature health care law -- though they are already well behind the timeline originally sketched out to complete the task this year. And other items on the president’s and Congress’ agenda -- namely tax reform and an infrastructure package -- are much more difficult to pass if the health care effort stalls.

“I think it makes it harder to move on to other things if we fail here,” Cornyn said. “This is more than just about health care, as important as that is. This is about keeping our promises, demonstrating our ability to govern and paving the way toward other important reforms like tax reform and getting the economy going.”

Alexis Simendinger covers the White House for RealClearPolitics. She can be reached at  Follow her on Twitter @ASimendinger.

James Arkin is a congressional reporter for RealClearPolitics. He can be reached at Follow him on Twitter @JamesArkin.

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