Senate Obamacare Repeal Now Hinges on Conservative Support

While moderates also have concerns, critics on the right were first out of the gate Thursday.

Sen. Ted Cruz arrives at the Capitol as Senate Republicans released their long-awaited bill to scuttle much of President Obama's Affordable Care Act on Thursday.
AP Photo/J. Scott Applewhite
Alex Rogers
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Alex Rogers
June 22, 2017, 8 p.m.

After sev­en years of prom­ising to “re­peal and re­place” Obama­care, the Re­pub­lic­an lead­ers in the Sen­ate fi­nally un­veiled a bill Thursday they said would do just that. But the bill wasn’t pub­lic for four hours be­fore four con­ser­vat­ive sen­at­ors an­nounced their op­pos­i­tion, threat­en­ing the Trump ad­min­is­tra­tion’s top pri­or­ity in Con­gress.

The sen­at­ors—Ted Cruz of Texas, Rand Paul of Ken­tucky, Mike Lee of Utah, and Ron John­son of Wis­con­sin—op­pose the cur­rent le­gis­la­tion for a vari­ety of reas­ons. Should they get what they want, the bill would move fur­ther to the right, fur­ther ant­ag­on­iz­ing the Re­pub­lic­an sen­at­ors who are already wary of sup­port­ing a bill that would elim­in­ate Medi­caid cov­er­age for mil­lions.

Rank-and-file sen­at­ors have been frus­trated with how the Re­pub­lic­an lead­er­ship craf­ted the bill, which did not re­ceive a hear­ing in a ma­jor de­par­ture from the nor­mal le­gis­lat­ive pro­cess. “How you rush this thing through and take a vote at the end of next week is really bey­ond me,” said John­son, who wants more in­form­a­tion and more time to eval­u­ate the draft with his gov­ernor and state. The Con­gres­sion­al Budget Of­fice plans to score the bill by early next week, per­haps a couple of days be­fore sen­at­ors vote on it.

But Sen. John Cornyn, the No. 2 Re­pub­lic­an, said Thursday that des­pite his col­leagues’ con­cerns, the Sen­ate will still vote on the bill next week be­fore mem­bers go home for the Ju­ly 4 re­cess.

“It doesn’t get any bet­ter,” said Cornyn. “It doesn’t get any easi­er.”

The draft le­gis­la­tion would elim­in­ate the Af­ford­able Care Act’s pen­alty ur­ging Amer­ic­ans to pur­chase health care in­sur­ance and the pen­alty re­quir­ing large com­pan­ies to provide it. It would cut bil­lions of dol­lars in fed­er­al fund­ing for Medi­caid by even­tu­ally elim­in­at­ing the ACA’s Medi­caid ex­pan­sion and chan­ging the pub­lic pro­gram for low-in­come people from an open-ended en­ti­tle­ment to a per cap­ita or block-grant pro­gram. It would cut taxes primar­ily on the af­flu­ent used to pay for the ACA and re­duce the sub­sidies help­ing Amer­ic­ans pur­chase health care on the fed­er­al ex­changes. It would al­low states to waive some policies, in­clud­ing re­quir­ing in­surers to provide for es­sen­tial health be­ne­fits such as ma­ter­nity treat­ment. And it would keep some pop­u­lar pro­vi­sions, such as al­low­ing chil­dren to stay on their par­ents’ in­sur­ance un­til they’re 26.

Some con­ser­vat­ives who had de­rided the House’s bill as “Obama­care-lite” would like to make fur­ther changes. In the meet­ing with his fel­low Re­pub­lic­an sen­at­ors Thursday morn­ing, Lee talked about his “need” to re­peal all the Title I reg­u­la­tions, which in­cludes pro­vi­sions elim­in­at­ing life­time an­nu­al lim­its on be­ne­fits and ex­tends de­pend­ent cov­er­age up to age 26, ac­cord­ing to a Lee aide. After the meet­ing, Paul re­leased a state­ment say­ing the bill “does not keep our prom­ises to the Amer­ic­an people” as it “does not re­peal Obama­care.”

One ed­it­or from the liber­tari­an Reas­on magazine said it might be “Obama­care lite—later,” not­ing the delays in many of the bill’s pro­vi­sions. An­oth­er from the Wash­ing­ton Ex­am­iner tweeted it “does more to res­cue Obama­care than it does to re­peal it.”

Out­side groups like Freedom­Works echoed Paul’s mes­sage, while health care ex­perts from the Her­it­age Found­a­tion said the bill should ex­pand its waiver au­thor­ity.

If the bill went to the floor today, it wouldn’t pass, since Re­pub­lic­ans can only af­ford to lose two out of 52 GOP sen­at­ors with zero Demo­crat­ic sup­port. And even if it could, it also likely wouldn’t be able to pass the House over con­ser­vat­ives’ con­cerns there. “I think we’re prob­ably go­ing to get a lot of push back from people from the Right in the House,” said Sen. Lind­sey Gra­ham.

Rep. Mark Mead­ows, the lead­er of the House Free­dom Caucus, said the “ma­jor­ity” of his arch-right group would sup­port the bill if Cruz is suc­cess­ful in in­sert­ing “con­sumer choice” pro­vi­sions. Mead­ows said the amend­ments would al­low for in­surers to com­pete across state lines and al­low people to use sub­sidies to pur­chase a plan that doesn’t meet the ACA’s stand­ards.

“We should do more to en­sure con­sumers have the free­dom to choose among more af­ford­able plans that are tailored for their in­di­vidu­al health care needs,” said Cruz in a state­ment. “As cur­rently draf­ted, this bill draft does not do nearly enough to lower premi­ums.”

Still, con­ser­vat­ives are hope­ful that they can still get sup­port for the ul­ti­mate bill in or­der to de­liv­er on their prom­ises. Cruz, who’s up for reelec­tion, noted that he’s worked on this bill for four months. While Cruz has ant­ag­on­ized his lead­er­ship al­most since he got to the Sen­ate, Cornyn says he’s “con­vinced” his col­league from Texas “wants to get to yes.”

Of course, it may not be enough. Oth­er Re­pub­lic­ans, such as Sens. Rob Port­man and Shel­ley Moore Capito, have their own con­cerns, in­clud­ing in­creas­ing the fund­ing to com­bat the opioid crisis. Mod­er­ate Sen. Susan Collins wants to ex­am­ine the im­pact on in­sur­ance cov­er­age; the House le­gis­la­tion in­creased the num­ber of un­in­sured by 23 mil­lion. And Sen. Dean Heller, per­haps the most vul­ner­able Re­pub­lic­an up for reelec­tion, has “ser­i­ous con­cerns” about the bill’s ef­fect on his state, which saw 200,000 Nevadans get in­sur­ance un­der the Medi­caid ex­pan­sion.

And oth­er con­ser­vat­ives be­sides Cruz might already be gone.

“Sen­at­or Paul, I think, has unique con­cerns that aren’t ne­ces­sar­ily shared by the oth­ers,” said Cornyn.

Jason Plautz contributed to this article.
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