The Republican party’s seven-year crusade to repeal the Affordable Care Act (ACA) is on the verge of collapse, after Senate leaders were forced to delay a vote on a healthcare bill that according to the Congressional Budget Office (CBO) would leave an estimated 22 million more people without health insurance by 2026.
Senate majority leader Mitch McConnell told Republicans in a closed-door meeting on Tuesday that he would postpone the vote until after the Fourth of July recess, in hope of cajoling senators from the moderate and conservative wings of the party. Donald Trump invited GOP senators to the White House, to seek to map out a way forward.
“We are going to continue the discussions within our conference on the differences that we have that we’ll continue to try to litigate,” McConnell told reporters. “Consequently, we will not be on the bill this week but we are still working toward getting at least 50 people in a comfortable place.”
McConnell flatly denied that a delay would further imperil the bill, despite concerns from some members of his caucus that Republicans will face pressure from constituents if they return home for a week-long break without a vote. The Kentucky Republican said the president was “anxious to help”.
During the afternoon meeting in the East room of the White House, Trump sat between senators Susan Collins of Maine and Lisa Murkowski of Alaska, both of whom have deep reservations of about the proposal’s slashes to Medicaid.
Trump said Republicans were “very close” to resolving their concerns with the legislation.
“This will be great if we get it done,” Trump said at the end of his opening remarks. “And if we don’t get it done, it’s just going to be something that we’re not going to like – and that’s okay. I understand that very well.”
Despite Trump’s apparent ambivalence, he told reporters: “I think the Senate bill is going to be great.”
Leaving a daily conference lunch, Marco Rubio said he hoped the White House was in “listening mode”.
“This is a very important issue – you’re dealing with people’s lives and their healthcare,” the Florida senator said. “I’d rather do it right than do it fast but obviously we can’t wait forever.”
A growing list of defections had imperiled the prospect of a vote to even begin debate on the Senate legislation, which would repeal and replace major components of the healthcare law signed by Barack Obama.
Several Republicans balked at a plan that also threatens coverage for maternity care, mental health and addiction and would impose a six-month waiting period on coverage for those who let their insurance lapse. That penalty was designed to boost continuous coverage but healthcare advocates warned it could be fatal for people with acute conditions such as cancer or heart ailments.
The Senate plan would also phase out the state-by-state expansion of Medicaid, which has covered millions of low-income, disabled and mentally ill people.
On Tuesday, three more Republican senators came out against the bill – but only after McConnell announced he would delay the vote. Senator Jerry Moran of Kansas said on Twitter that the bill “missed the mark” and did not have his support.
Soon after, senators Rob Portman of Ohio and Shelley Moore Capito of West Virginia issued a joint statement that said the bill did not do enough to combat the opioid epidemic that has devastated their states.
“As drafted, this bill will not ensure access to affordable healthcare in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply, and harms rural healthcare providers,” Capito said.
With their opposition, nine Republican senators have rejected the measure in its current form, including senators Collins, Rand Paul of Kentucky and Dean Heller of Nevada.
The highly anticipated CBO score, released on Monday, dealt a major blow, projecting that 15 million more people would be uninsured over the next year alone. That number would tick up to 19 million by 2020 and 22 million by 2026. The CBO had predicted that the healthcare plan passed by House Republicans last month would leave 23 million more uninsured over a 10-year period.
Republicans, who hold the Senate 52-48, must find at least 50 votes to pass the bill, under a budget rules process known as “reconciliation” that would require only a simple majority. If the chamber were split 50-50, vice-president Mike Pence would cast the tie-breaking vote.
The Senate legislation would reduce the federal budget deficit by $321bn over a decade, largely due to its steep cuts to Medicaid, the CBO report found. But the analysis foresaw enrolment for people under 65 years old falling by 16% by 2026. Current projections show that under current law, 28 million Americans will be uninsured over the next decade. That number would rise to 49 million under the Senate proposal, the CBO said.
“[It] confirmed my worst fears about the impact of the bill on coverage,” Collins told reporters on Tuesday.
The Maine senator said she and Lisa Murkowski, a Republican from Alaska, were working on an amendment to do away with a provision in the bill that would defund Planned Parenthood for one year.
Such a move would assuredly meet stiff resistance from most Republicans, who have voted nearly every year to eliminate federal funding for Planned Parenthood even though law bars taxpayer dollars from being used for abortions.
Trump has called for a bill that “involves heart”. But the president may have lost leverage with lawmakers by confirming that he indeed referred to the bill passed by the House in May as “mean”.
Democrats have seized on the president’s characterization.
“If the House bill doesn’t have a heart, the Senate bill doesn’t have a soul,” Senator Joe Manchin, from West Virginia, said on Tuesday.
The Ohio governor John Kasich, a Republican, joined Colorado governor John Hickenlooper, a Democrat, in Washington to urge Senate Republicans to abandon the current proposal, which he called both “inadequate” and “unacceptable”.
“We have a healthcare civil war going on,” Kasich said at the National Press Club. “It’s all about recriminations.”
He implored Democrats to work with Republicans on a bill that would not be so devastating to Medicaid enrollees. Democrats have said they are willing to work on improving the ACA, but remain unified in their opposition to repealing it.
The governors acknowledged the political pressure on Republicans to support the bill. America First Policies, a Super Pac backing Trump, announced a $1m ad campaign against Heller in Nevada.
Democrats nonetheless warned that the battle was far from over. “It’s not jubilation,” said Dick Durbin, the Senate minority whip, of the mood in the party. “It’s, frankly, relief.”
Chuck Schumer, the Senate minority leader, urged his caucus and liberal groups to keep up the pressure.
“No matter how the bill changes around the edges, it is fundamentally flawed at the center,” he told reporters, adding that Democrats were open to working with Republicans on improving the ACA, under two conditions.
Republicans, he said, must abandon their effort to repeal the law entirely. Secondly, they must retreat from aiming to eliminate ACA taxes – a central plank of their overhaul plan.
The Connecticut senator Richard Blumenthal, a Democrat, told reporters anything was still possible.
“Our mantra is: ‘Do not underestimate Mitch McConnell.’”
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