Senate Republicans are in for a rough, if not impossible time passing their latest health care plan to repeal and replace President Barack Obama’s Affordable Care Act.
A draft carefully-crafted in secret and designed to appeal to the GOP’s conservative right and moderate wings managed to do neither when its details were finally unveiled on Thursday.
Just a few hours after Senate Majority Leader Mitch McConnell, R-Ky., revealed his proposal’s contents, Republican senators from the middle and the right quickly raised objections to key elements or offered tepid reactions.
“It does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their healthcare costs,” said a statement from four other conservative Republican senators.
Among other senators, Sen. Marco Rubio, R-Fla., said he would “continue to reach out for input and suggested changes from Florida providers, insurers and patient advocate groups.”
Senate Republican leaders can afford to lose only three GOP votes for their plan, since chamber’s 46 Democrats and two independents are expected to vote no on any bill that does away with Obamacare. Vice President Mike Pence would break a 50-50 tie.
But to get to even 50, Republicans have a lot of persuading and rewriting to do on a host of concerns, including abortion policy, Medicaid expansion and whether the plan follows the “Jimmy Kimmel test.” The ABC late night talk show host stirred lawmakers recently with an emotional description of his infant son’s hospitalization, urging that people have access to medical attention.
They need to convince wavering lawmakers such as Sen. Dean Heller, R-Nevada, considered next year’s most vulnerable Senate Republican up for re-election.
"At first glance, I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid," Heller said. "As I have consistently stated; if the bill’s good for Nevada, I’ll vote for it and if it’s not – I won’t."
The dividing lines:
Sens. Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah, and Ron Johnson of Wisconsin issued a short, terse, joint statement that said "we are not ready to vote for this bill" while also stating that it does contain elements "that represent an improvement to our current healthcare system."
Their main complaint: The GOP plan doesn’t do enough to dismantle the Affordable Care Act. Paul dismissed the bill as "Obamacare-lite," referring to the Republican bill’s continuation of several of the Affordable Care Act’s regulations.
Sens. Susan Collins of Maine and Lisa Murkowski of Alaska expressed reservations about the bill for provisions that defund Planned Parenthood, a medical services provider that performs abortions, for one year and limit the use of tax credits to purchase health care plans that provide abortions, except in cases of rape, incest, or if the life of the mother is in danger.
"I am opposed to the defunding of Planned Parenthood," Collins said. "I think it’s unfair and shortsighted to take one provider out of the Medicaid program."
Collins noted that there’s already a law in place, the Hyde Amendment, that bans the use of federal funds for abortions.
If the language defunding Planned Parenthood for one year remains, Collins said she and Murkowski will offer an amendment to remove it, and that could invite anger from many anti-abortion conservatives.
Asked if it would cost her vote if her amendment failed, Collins demurred and added "Well, I’m hoping we will win."
The bill received a less than enthusiastic welcome from several Republican senators. Sen. Lindsey Graham, R-S.C., said South Carolinians deserve better than Obamacare but added "Only after a careful review of the (GOP) legislation will I be able to determine if this bill achieves those goals."
Sen. Bob Corker, R-Tenn., said he "will make a final decision based on whether this legislation, on the whole, is better than what is in place today."
Sen. Jerry Moran, R-Kansas, said he has "concerns about what the changes to Medicaid may mean to those with disabilities" and to rural hospitals in his home state. Moran said he would take his time to examine the legislation. The proposal makes big cuts in Medicaid, the joint state-federal program that helps provide care to low-income adults and others.
"I know that if it doesn't meet the needs of Kansans, it won't get my vote," he said.
Senate Republican leaders stressed that the release of the Republican health care bill was the beginning, not the end, of the process. There will likely be alterations in hopes of getting wary Republican senators to "yes."
"I’m optimistic," Senate Majority Whip John Cornyn, R-Texas, told reporters. "I talked to Sen. Cruz. I understand what he wants. And I think he’s being constructive. I think he wants to get to yes."