Rocky rollout for Senate healthcare bill

The Senate healthcare bill had a rocky rollout on Thursday as Republican senators complained it doesn’t do enough to repeal ObamaCare or lower healthcare costs.

The blowback raised doubts over whether Senate Majority Leader Mitch McConnell (R-Ky.) will be able to stick to his aggressive schedule of voting on the proposal next week. 

Senate Republicans control 52 seats and can only afford two defections, as every Democrat is expected to vote no. 

As of now, McConnell is at least two votes short of a majority — and maybe more.

Four conservative Republican senators, Sen. Rand Paul (R-Ky.), Mike Lee (Utah), Ted Cruz (Texas) and Ron Johnson (Wis.), released a statement Thursday afternoon announcing they don’t support the legislation, though they are open to negotiation. 

On the other side of the GOP’s ideological spectrum, several moderates voiced misgivings about the bill’s impact on constituents enrolled in Medicaid. 

Sen. Dean Heller (R-Nev.), the most vulnerable Republican senator facing reelection next year, said he has “serious concerns about the bill’s impact on the Nevadans who depend on Medicaid.

Sen. Susan Collins (R-Maine), another centrist, criticized the bill’s effort to rein in Medicare costs starting in 2025 by indexing it to a lower inflation measure than what House Republicans used in their bill.  

“It is lower than the cost of medical inflation and would translate into literally billions of dollars of cuts and that would mean states would be faced with very unpalatable cases of restricting eligibility or allowing rural hospitals to go under,” she said in a statement. 

Sen. Rob Portman (R-Ohio) said he continues “to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic.”

Facing a momentous vote that could define their careers, nervous GOP lawmakers are hitting the brakes to give themselves more time to review the legislation and check in with constituents, stakeholder groups and home-state officials.

“I don’t see how I can get the information I’m going to need to get to yes within a week,” Johnson told reporters, adding he wants to speak to doctors and hospitals.

GOP leaders pushed back on talk of delaying the vote until after the July 4 recess, saying there are other agenda items that need attention and that delay accomplishes little. 

“It doesn’t get any easier,” said Senate Republican Whip John Cornyn (Texas). “We’ve got other things we need to do, like the defense authorization bill.” 

Cornyn said Republicans also need to pass another budget resolution to move forward on tax reform, negotiate spending caps and raise the federal debt ceiling.

A senior Senate Republican aide said the complaints from rank-and-file members about the bill were expected, as many of them would prefer to avoid casting a politically tough vote next week.

“This is forcing senators to make a decision and a lot of them don’t like that,” the aide said. “Some of them would prefer to never answer the question.”

McConnell argued on the floor that the party has a responsibility to address ObamaCare.

“For our constituents. For our states. For our country. We’ve long called for a better way forward. And we’ve been engaged in intensive talks on how to get there,” he said, noting that there have been dozens of meetings to which every member of his conference has been invited to attend.

GOP leaders will negotiate with the conservative rebels over the next few days in hopes of bringing them on board.

They have slim hopes of winning over Paul, the most critical of the group, but think they can persuade Cruz and Johnson to change their minds. Lee is also seen as a reach. 

“We’re working with them. I’ve talked to Sen. Cruz and I’m convinced he wants to get to yes, but he has certain concerns that he’s made clear to us and we’re going to work the best we can to accommodate him,” Cornyn said.

Cruz handed out cards at the Senate Republican lunch Thursday, two hours after the bill was posted online publicly for the first time, laying out what changes he wants to be made.

He wants to add a provision that would allow insurance companies that sell plans meeting ObamaCare’s mandates to also have the freedom to sell plans that do not meet those mandates.

He is pushing to give states flexibility in the law to design Medicaid programs without requiring waivers from the secretary of Health and Human Services.

And Cruz is calling for a host of “consensus” market reforms such as allowing consumers to purchase insurance across state lines. 

Lee, Cruz and Johnson are concerned the GOP proposal won’t do enough to lower insurance premiums because it leaves in place ObamaCare’s insurance regulations, which require companies to sell health plans to people with pre-existing conditions and not price those plans to reflect the risks of insuring sicker people. 

“I don’t think there’s enough, probably, in there to bring down those premiums, which I think is a problem with both the House and maybe the Senate bill now,” Johnson told reporters. 

Cruz in a separate statement said, “as currently drafted, this bill does not do nearly enough to lower premiums.”

As expected, Democrats immediately assailed the bill, calling it a “meaner” version of the unpopular House healthcare measure.

“The Senate version of ‘TrumpCare’ is even meaner than the House bill,” Senate Democratic Leader Charles Schumer (N.Y.) told reporters at a press conference. 

“The bill takes dollars out of healthcare for millions of Americans and puts them right back in the pocket of the wealthy,” he said. 

He noted the legislation would cut taxes for high-income earners while defunding Planned Parenthood for a year and cutting Medicaid.

And he argued it would cause healthcare costs for low-income and middle-class families to go up by cutting back on tax credits to help people buy insurance on government run exchanges.

More surprising was the harsh reception the legislation received from Senate Republicans who held a special conference meeting to review the legislation Thursday morning. 

Up until that point, GOP senators had kept their criticisms quiet. But once GOP leaders publicly posted the draft online, they quickly made their feelings known. 

“This bill probably, we think, more ObamaCare subsidies or at least as much as is already in ObamaCare,” Paul said. “When you add in the stabilization fund and you look at subsidies, we’re looking at something that may exceed ObamaCare.”

In addition to hundreds of billions of dollars in tax credits and subsidies to help lower-income people buy health insurance plans, the proposal would appropriate $50 billion over four years to stabilize ObamaCare’s insurance exchanges. 

Peter Sullivan and Nathaniel Weixel contributed.