The Wish Lists That Could Doom Obamacare Repeal

Several Republicans are against or wavering on the GOP health bill, and each one has a different set of demands.

Sen. Susan Collins speaks amid a crush of reporters Thursday after Republicans released their long-awaited bill to scuttle much of the Affordable Care Act.
AP Photo/J. Scott Applewhite
Alex Rogers
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Alex Rogers
June 26, 2017, 8:41 p.m.

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.

Erin Durkin contributed to this article.
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