The pitched battle to kill or fix the GOP’s Obamacare replacement bill now moves to the Senate, where patient advocacy and health care groups are vowing to keep up the pressure on lawmakers while seeking a more substantive debate on the bill’s controversial policies.
While the fight to repeal the Affordable Care Act has centered on the House of Representatives, these advocacy groups have been in discussions with Senate staff all year. Those talks will only intensify as the battle evolves in the upper chamber.
“The Senate clearly is a different beast than the House,” said Paul Billings, senior vice president for advocacy at the American Lung Association. “The staff in all the Senate offices have greater knowledge about how health care works.”
For groups like the American lung, heart and diabetes associations, whose complicated missions require complicated advocacy, an informed listener only helps their case.
The Senate clearly is a different beast than the House. The staff in all the Senate offices have greater knowledge about how health care works.
Paul Billings, senior vice president for advocacy at the American Lung Association
“We hope the Senate will move slowly and deliberately,” Billings said. “We hope there’ll be an opportunity for organizations to actually engage on substance. We weren’t afforded that conversation in the House process.”
Senate Majority Leader Mitch McConnell plans to bring the bill to the floor through a budget procedure known as reconciliation that requires a simple majority and would bypass Democratic attempts to filibuster.
But Billings said not much is known after that.
“We’re not quite sure at this point what elements of this bill will survive the Senate rules with respect to (budget) reconciliation, so there’s a lot of unknowns,” Billings said. “But certainly, the Senate is more manageable because of the number of people. But it’s a more complicated place.”
Paul Melmeyer, director of federal policy at the National Organization of Rare Diseases, said his organization wants to be helpful to Senate Republicans as they begin efforts to rewrite or replace the house measure. Two Republican senators must vote against the repeal legislation to defeat it.
Cory Gardner is the only U.S. senator in a state won by Hillary Clinton that still has a 100 percent Trump voting record. At some point, his survival instincts have to kick in.
Ian Silverii, executive director of Progress Colorado, whose group will target Gardner with lobbying efforts
Melmeyer said his group wants to work the middle of the debate.
“We’re not in the camp that says absolutely nothing needs to be done. Nor are we in the camp that says we should throw it all out entirely,” Melmeyer said. “We think there’s absolutely a middle ground” for compromise.
But he acknowledged that problems with rising premiums, health plans leaving the marketplace and a lack of younger healthy enrollees must be addressed.
“There’s plenty in the Affordable Care Act that we’re supportive of, and we would not want to see a rewrite of those specific sections,” Melmeyer said of provisions that require plans to cover 10 essential benefits and prohibit discrimination against people with pre-existing conditions. “That said, we still acknowledge that there is plenty within the ACA that is not working right now.”
But just like the House debate, where the politics and policy played nearly equal roles, the Senate debate will also be defined by the polarizing politics of Obamacare.
The evidence was on display just minutes after Thursday’s vote. Ian Silverii, executive director of Progress Colorado, said his organization and other pro-ACA groups will target Sen. Cory Gardner, R-Colo., for a fierce lobbying effort on the legislation.
A similar effort by progressive groups in Colorado helped flip Rep. Mike Coffman, R-Colo., from voting for the GOP bill to voting against it on Thursday, Silverii said.
“Cory Gardner is the only U.S. senator in a state won by Hillary Clinton that still has a 100-percent Trump voting record,” Silverii said Thursday. “At some point, his survival instincts have to kick in and he has to look around and realize that Trump is unpopular. Trumpcare is unpopular. And if he wants to keep his seat in 2020, he has to do the right thing.”
Isaiah Poole, director of communications with the People’s Action Institute, said his organization will be active next week during the congressional recess.
“We have a list of Senate targets,” Poole said. That list includes Republicans Sens. Susan Collins of Maine and Rob Portman of Ohio, both of whom have voiced concerns with the House proposal.
Portman, Gardner and other Republican senators from states that expanded eligibility for Medicaid under the ACA should expect a heavy dose of pressure from patient and advocacy groups.
Janel George, the director of federal reproductive rights and health with the National Women’s Law Center, said her group, along with many others, will target specific senators as the bill heads to the upper chamber for passage.
“Everyone needs to hear from us,” George said. “We need to remind people what’s at stake. Everyone needs the education, everyone should get the outreach.”
George said her group will encourage members to call all Republican senators to urge them to vote against the bill if it makes it to the floor.
Alex Daugherty contributed to this report.