The hunt is on.
Senate Majority Leader Mitch McConnell is finding it increasingly difficult to corral 50 out of 52 Senate Republicans and pass a bill reforming much of the Affordable Care Act, imperiling one of the Trump administration’s top priorities in Congress and the core promise Republicans have made to their voters for years.
Republican leaders has targeted a vote towards the end of the week, but four of their rank-and-file senators—Ron Johnson of Wisconsin, Susan Collins of Maine, Dean Heller of Nevada and Rand Paul of Kentucky—indicated Monday that they won’t support a procedural vote, potentially dealing a critical blow to the bill. A few more Republicans are wavering—each for slightly different reasons—making McConnell’s task especially tricky.
The intraparty criticism comes after the Congressional Budget Office announced Monday that the bill, known as the Better Care Reconciliation Act, would increase the number of uninsured Americans by 22 million, and cut over $500 billion in revenues primarily through cutting taxes on the affluent and more than $770 billion in Medicaid spending reductions over the next 10 years. While some Republicans pointed out the positive—the bill would ultimately lower premiums by 20 percent and decrease the deficit by $331 billion—others recognized the political peril for voting in favor of the bill. Heller, perhaps the most vulnerable Republican senator up for reelection in 2018, came out against the bill last week.
“If you’re on the fence—you were looking at this as a political vote—this CBO score didn’t help you,” said Sen. Lindsey Graham on Monday.
The GOP leadership now must act quickly to push through the vote before members go home for the July 4 holiday. Here are eight senators to watch out for:
Susan Collins of Maine
Perhaps the Republicans’ most moderate senator, Collins has prioritized coverage during the entire health care debate this year. On Monday night, she tweeted that she would not vote to advance the bill because “access to healthcare in rural areas [is] threatened,” noting the deep cuts to Medicaid. The bill also denies funding for Planned Parenthood for a year, an idea she recently said on ABC “makes absolutely no sense.”
“I want to work w/ my GOP & Dem colleagues to fix the flaws in ACA,” tweeted Collins on Monday night. “CBO analysis shows Senate bill won't do it.”
Ron Johnson of Wisconsin
Last year, many Republicans counted Johnson out long before he won on Election Day. He doesn’t owe his victory to the Senate GOP leadership, and has criticized its process as secretive and rushed. On Monday night, he said, “I have a hard time believing I will have enough information” to support a procedural vote on the bill. His other criticisms lie in the bill not being conservative enough; “Like Obamacare, it relies too heavily on government spending,” he wrote in a New York Times op-ed.
Rand Paul of Kentucky
Paul has always been viewed as one of the most difficult votes to get. The president has recently talked to Paul, but Senate leadership has not, according to Paul and his staff. When Trump and Paul spoke, the senator “reiterated his issues with the current bill—how it isn't serious repeal, and what things he will need to be convinced it can lower costs for Americans,” according to Paul spokesman Sergio Gor.
“We promised repeal; we didn’t promise that we were keeping Obamacare,” Paul told reporters on Monday. “But if we don’t fundamentally fix the marketplace we’re going to own health care.”
“I think there’s actually more blame to be attached to not doing a real thorough fixing than there is to doing nothing,” he added.
Ted Cruz of Texas
The man who led the 2013 government shutdown over defunding Obamacare says he wants to get to yes, even though he has been involved for months with the working group that came up with the bill. But so far, Cruz has withheld his support, saying that premiums need to decrease not only over time, but in the next couple of years, too. He also has concerns over process, saying on Monday night that “reforms to lower premiums need to be reflected in the base bill” rather than through the amendment process.
“CBO projected the next two years would go up 30 percent,” Cruz told reporters on Monday. “That’s a disaster. That’s the disaster that’s already happening with Obamacare. This current draft doesn’t solve that problem.”
Rob Portman of Ohio
Portman hails from one of the 31 states that expanded the Medicaid program under the Affordable Care Act, which has helped his constituents obtain access to treatment through Medicaid. Portman and Sen. Shelley Moore Capito of West Virginia have requested $45 billion over 10 years to respond to the opioid crisis. The current bill only has $2 billion, so look for Portman and Capito to push for more funding.
Dean Heller of Nevada
Heller is perhaps the most vulnerable Republican senator up for reelection in 2018. Nevada Gov. Brian Sandoval, who is popular in the state, has defended the Medicaid expansion as a reason for the state’s declining uninsured rate. In a press conference last week with Sandoval, Heller said that he would not support the bill as written, saying it’s a “lie” that it would lower premiums, and that in fact it would take insurance away from “hundreds of thousands” of Nevadans.
Mike Lee of Utah
Lee, a staunch conservative, would not vote for the current bill, outlining in a statement last week his grand price: an “opt-out” provision for states and/or individuals that would greatly change the contours of the bill.
“Far short of ‘repeal,’ the Senate bill keeps the Democrats’ broken system intact, just with less spending on the poor to pay for corporate bailouts and tax cuts,” he wrote.
Lisa Murkowski of Alaska
On Monday night, Murkowski said on CNN that she doesn’t have “enough data” to vote for the bill, echoing the concerns of Johnson and others. Murkowski, who has built a brand on her independence from Republican leadership, wants greater access and reduced costs, but repealing the Medicaid expansion would curtail coverage in her state. Alaska has some of the highest health care costs in the country, and early analyses of the Senate bill have found that it would increase premiums, particularly for older people, over Obamacare.