Senate Republican leaders are desperately searching for the 50 votes they need to open a debate on ObamaCare repeal-and-replace legislation after a Wednesday scolding at the White House from President Trump.
Leaders have reopened negotiations on their previous bill, reversing course from their plans to move to a vote on a straight repeal of ObamaCare.
But it’s not clear if they will have any more luck this time in corralling enough centrist and conservative Republicans to move the bill forward.
Senate Majority Leader Mitch McConnell (R-Ky.) needs to win 50 votes to proceed and has faced opposition from conservatives, who believe the previous bill kept too much of ObamaCare, and centrists, who think it would leave too many people without affordable insurance.
GOP leaders haven’t closed the door on bringing a straight repeal of ObamaCare, with a two-year delay, to the floor.
But Trump, who has given mixed messages on whether he wants to just repeal or simultaneously repeal and replace ObamaCare, on Wednesday told Republican senators at a White House lunch that repealing ObamaCare without a replacement was not an option.
“We can repeal it, but we should repeal it and replace, and we shouldn’t leave town until this is complete, until this bill is on my desk,” Trump said.
McConnell appears to believe that if he can get the Senate to agree to open debate on an ObamaCare measure, he’ll have an opportunity to clear legislation by grinding away at his members. As the pressure intensifies, he clearly hopes that opposition will fall away.
But he first must get past the motion to proceed.
“Next week, we’ll be voting on the motion to proceed, and I have every expectation that we’ll be able to get on the bill,” McConnell told reporters Wednesday at the White House.
McConnell has failed three times so far to win the support that he needs.
A mix of conservative and centrist senators said they would oppose a procedural motion to begin work on an initial repeal-and-replace bill.
That led to a new round of negotiations and a second repeal-and-replace measure largely similar to the first bill.
On Monday, it became clear that the new bill also lacked the support to advance in the Senate.
McConnell then signaled he’d abandon repeal-and-replace, saying the Senate would seek to advance legislation repealing ObamaCare — with no guarantee on any replacement.
Centrists then came out against that plan, too.
After the Trump meeting, GOP leaders changed course and signaled a third effort to win support for a repeal-and-replace bill.
Senate Majority Whip John Cornyn (R-Texas) told reporters after the lunch that while the repeal-only bill might come to the floor, he preferred to negotiate a version of the repeal-and-replace bill, known as the Better Care Reconciliation Act (BCRA).
“If we can get an agreement here, my preference would be to start with the BCRA, agree to language — and I think we’re getting closer,” he said.
Senators were expected to meet Wednesday evening in Sen. John Barrasso’s (R-Wyo.) office with Vice President Pence, Health and Human Services Secretary Tom Price and Seema Verma, administrator for the Centers for Medicare and Medicaid Services, to discuss the bill. At press time it was not clear which senators would attend the meeting.
“There are going to be some meetings tonight up here with people who still have outstanding issues, and I think the question will be, yeah, can we find a way to get to yes?” said Sen. John Thune (S.D.), the Senate’s No. 3 Republican.
Leaders face the same problem that has bedeviled them since the beginning. If the bill is moved to the right, moderate senators are lost. If the bill moves to the center, conservative senators defect.
The bill’s treatment of Medicaid is a major sticking point for moderates.
The latest attempt to win over members is being called a “Medicaid wraparound.”
This would allow states to take money allocated to them through Medicaid and use the money to cover healthcare expenses for people who no longer qualify for Medicaid because the program’s expansion ended.
The idea is to make up for the reduction of federal funding for ObamaCare’s Medicaid expansion, which would be curtailed by the Senate bill. Under the previous bill, states are given federal tax credits to help people who would no longer quality for Medicaid, but senators have expressed fears that this will not be a big enough pool — particularly considering the nation’s opioid epidemic.
But the plan would actually involve taking more money away from Medicaid, which would already see its federal funding reduced under the Senate bill.
Verma discussed the proposal at the White House lunch.
“She explained very briefly, very, very briefly some of the parameters of what they’re calling this wraparound for Medicaid,” said Sen. Lisa Murkowksi (R-Alaska), one of the moderates who has threatened to vote against a motion to proceed to the bill.
Despite all the problems they’ve had with their ObamaCare effort, a number of Senate Republicans said they believe they are close to getting enough votes on a repeal-and-replace bill.
McConnell’s move to bring a repeal-only bill to the floor “brought it to a head, and he offered one way forward,” Sen. Mike Rounds (R-S.D.) told The Hill after the lunch at the White House. “A lot of us went back in and talked with leadership and said, ‘Look, we’re close enough on this, we put a lot of work into this, we don’t want to go that route.’ ”
They are also facing increasing pressure from groups warning of political repercussions if they fail.
The conservative group FreedomWorks said they will hand out “traitor” awards to Republicans who oppose a healthcare procedural vote next week.
And the conservative Club for Growth said it will track the motion to proceed leading to a vote on a repeal-only bill as a “key vote,” warning that voting against it would be “tantamount to supporting ObamaCare.”