Shortly after Senate Majority Leader Mitch McConnell unveiled a revised bill last Thursday to overhaul the US healthcare system, lawmakers undecided about the proposed changes to Medicaid gathered together in the Kentucky Republican’s office in search of a solution.
The members, which included Sens. Lisa Murkowski of Alaska, John Hoeven of North Dakota, Shelley Moore Capito of West Virginia and Rob Portman of Ohio, were also joined by Centers for Medicare and Medicaid Services Administrator Seema Verma, according to Roll Call.
And as Republicans look to seize on a rare opportunity to pass a massive entitlement overhaul, resistance within their conference threatens that, as well as their seven-year mission to repeal and replace former President Barack Obama’s signature domestic achievement.
As Jeff Young of HuffPost wrote: “Portman going with ‘undecided’ but, again, the Medicaid policies in the bill are THE SAME as in the old bill.”
Broadening the point beyond Portman, Dylan Scott of Vox noted that the only way for Senate Republicans to pass a version of this bill is to “ignore everything they’ve said” about their healthcare priorities.
“We’re just going to keep talking and keep looking. Still a lot of unanswered questions,” Capito told reporters leaving McConnell’s office. “No decision made.”
While in the meeting, Capito’s office released a statement saying she still had “serious concerns about the Medicaid provisions.” Two Republicans–Sens. Rand Paul of Kentucky and Susan Collins of Maine–have already vowed to oppose the motion to proceed to the measure.
Following the release of the CBO analysis of the updated draft, expected this week, McConnell can only afford to lose the support of one more Republican member and still call in Vice President Mike Pence to break a 50-50 tie.
That was last week.
This week started with Senate Republican leaders returning to the Capitol pledging to press ahead with plans to pass a sweeping overhaul of the nation’s healthcare system–but uncertainty about the health of Sen. John McCain (R-AZ) thrust the future of their wilting effort deeper into doubt.
In a speech on the Senate floor, Majority Leader McConnell said he spoke with McCain Monday morning and “he’ll be back with us soon,” according to The Washington Post. The Arizonan is recovering at home from surgery to remove a blood clot above his left eye that involved opening his skull.
“The only way we’ll get there is with continued hard work, and that’s just what we intend to do,” McConnell said.
However, the timetable on which that could happen was not clear. McCain, 80, is awaiting the results of tissue pathology reports “pending within the next several days,” the hospital treating him said in a statement over the weekend. He will be away from the Senate for at least the rest of the week. A McCain spokeswoman had no further update on his condition Monday (July 17, 2017).
GOP leaders have decided to put off the vote until after McCain returns. But even with him in the Senate, the bill is in peril. The Arizonan is among the many key Republicans who have worried about the substance of it, though he has left to door open to supporting it.
Senate Republicans are under self-imposed pressure to complete their work on health care soon. As they have struggled to show progress, McConnell has already said he will keep the chamber in session through the first two weeks of August, postponing the start of the summer recess period to leave time to work on other matters.
Key Republican senators–and the GOP governors they turn to for guidance–have raised concerns about how the bill would affect the most vulnerable people in their states. Private lobbying by the White House and Senate GOP leaders has not placated them.
Democrats are pressuring Republicans to use this week’s delay to hold public hearings on the controversial GOP bill. All 48 members of the Democratic caucus–along with two Republicans–oppose the legislation.
“This will allow members to hear unfiltered and unbiased analysis of how the bill will affect their states and the health and financial security of the constituents they represent, including the impact of Medicaid cuts to vulnerable populations like children, people with disabilities, and people with pre-existing conditions,” wrote Senate Minority Leader Charles E. Schumer (D-NY) and two other leading Democratic senators in a Monday letter to McConnell and a pair of GOP committee chairmen.
New York Attorney General Eric Schneiderman, a Democrat, also threatened Monday to sue the federal government if the healthcare bill becomes law. The measure “isn’t simply unconscionable and unjust. It’s unconstitutional,” he claimed on Twitter.
The CBO has been projecting what the bill would do to insurance coverage levels, premium costs and the federal budget deficit. Having an unfavorable report in the public domain for an extended period of time with an uncertain date for a vote would fuel critics’ argument against the bill, probably making it harder for McConnell to round up votes for it.
White House officials have been seeking to cast doubt on the findings from the earlier CBO and other independent analyses of the bill. But some key Republicans have responded to their pitch with skepticism. Over the weekend, influential Republican governors said they were not sold, even after talking privately with the officials during the National Governors Association’s summer meeting.
Still, McConnell is going for broke. He included an additional $45 billion in funding to help states combat the opioid epidemic, a nod to Portman and Capito, whose states have been ravaged by prescription drug abuse. For Murkowski, he included a provision that will direct more of the proposed stabilization fund to Alaska.
“We have been working to make sure that high-cost states have some way forward, and you see that reflected on that provision,” Murkowski told reporters walking outside the Capitol, claiming credit for that language along with her state GOP counterpart Sen. Dan Sullivan.
This new bill does have some substantially different details, including fewer tax cuts for the affluent. But it still has large tax cuts for the affluent, as Paul Krugman explains.
And the core of the bill remains big cuts in federal spending on medical care for the poor, middle class, sick, disabled and elderly. As a result, the main effect of this bill is the same as the Senate’s and House’s earlier versions: It would damage the quality of health care for millions of people.
As Larry Levitt, an expert at the Kaiser Family Foundation, noted, the new bill will likely lead to a similarly sharp increase in the uninsured as the previous bills would have. Unfortunately, Senate Republican leaders are following the same “Upton strategy” that House leaders did. They are hoping that late, modest changes to the bill will distract from the bill’s dominant features.
The key question for the bill’s future at the moment is when will McCain return to the Senate. The statement from McCain’s office suggested he would be out only this week, but its explanation for the procedure prompted some medical experts contacted by The New York Times to suggest he could be out of longer than expected, depending on the specifics.
A craniotomy is when surgeons open the skull, and the recovery time from such an operation “is usually a few weeks,” said Dr. Nrupen Baxi, a neurosurgeon at New York’s Albert Einstein College of Medicine.
I doubt that there are many Republican senators left who question whether the GOP push to replace the Affordable Care Act is getting increasingly unpopular and attracting more opposition from medical and insurance groups, a few key Republican governors, and liberal groups.
“The McCain absence gives Mr. McConnell and the White House a chance to continue working on holdout senators without having to back down from a vote this week,” The Wall Street Journal explains. “But it also creates a window for the 2010 health law’s supporters to continue a fight they believe is more likely to be successful the longer they wage it.”
The bill’s GOP proponents and outside analysts say they think the bill will be harder to pass the longer it is delayed, too.
“The longer the bill languishes, the less likely it will pass,” Greg Valliere, chief global strategist at Horizon Investments, tells The Wall Street Journal. “While McCain’s absence complicates the health debate, it already was in deep trouble, even when he was healthy.”
How ironic it seems that Sen. McConnell’s every heretofore masterly maneuvering to repeal and replace Obamacare has been thwarted by the tick of the clock, on this occasion by the unfortunate health situation of that “crusty voice in Washington,” as President Trump dubbed Sen. McCain on Monday.Steve's Take: #Obamcare will continue resembling a black fly in @realDonaldTrump's chardonnay Click To Tweet
The weekend’s developments suggest that Mr. Trump’s fierce determination to rid the political lexicon of “Obamacare” just mean that the term will continue resembling a black fly in his chardonnay.