The Republican senators at the forefront of the latest effort to undo the Affordable Care Act proposed Monday sending more health-care dollars to the states of key holdouts, hoping to keep their bill viable as it faced a wall of resistance on Capitol Hill.
Republican Sens. Bill Cassidy (La.) and Lindsey O. Graham (S.C.) have given more money to Alaska and Maine — two of whose GOP senators, Lisa Murkowski (Alaska) and Susan Collins (Maine), respectively — have expressed concerns but not yet declared how they would vote on the measure.
But there was little evidence Monday that the changes would secure enough votes for the legislation’s passage. Sen. Rand Paul (Ky.), who is one of two GOP senators against the bill, reiterated his opposition to the updated measure, and the other lawmaker, Sen. John McCain (Ariz.), has objected to it on the grounds that there has been no bipartisan outreach.
In an interview Monday, Cassidy said he hoped that the new language — coupled with the fact that failing to act would keep the current Obama-era health law intact — would persuade some colleagues to change their positions.
“If there’s a billion more going to Maine … that’s a heck of a lot,” Cassidy said. “It’s not for Susan, it’s for the Mainers. But she cares so passionately about those Mainers, I’m hoping those extra dollars going to her state … would make a difference to her.”
A vote by Collins or any other senator would be enough to defeat the bill, since no Democrats are expected to support it. Republicans hold a 52-to-48 advantage in the Senate and can lose only two votes from their party and still pass legislation with the help of a tiebreaking vote from Vice President Pence.
Several Republicans close to the process have long counted Collins as an eventual no, predicting that little could be done to the bill to change her mind.
The last-minute changes over the weekend, which come as GOP leaders are racing to pass legislation before losing the budget authority on Oct. 1 that lets them to pass legislation by a simply majority, underscore the tense atmosphere on the Hill. Outside the room where the Senate Finance Committee is slated to hold a hearing on the bill at 2 p.m., 60 police officers lined up shoulder-to-shoulder as protesters and audience members waited to go inside. A large group of patient advocates held a rally in the hallway, while the high number of attendees in wheelchairs prompted the press gallery staff to reduce the number of spots available to reporters.
The Cassidy-Graham legislation would overhaul the Affordable Care Act by lumping together the current law’s spending on insurance subsidies and expanded Medicaid and redistributing it to states in the form of block grants. Alaska would get 3 percent more funding between 2020 and 2026 than under current law, and Maine would get 43 percent more funding during that period under the updated bill.
While the figures in the revised bill draft aim to ease concerns of several key senators, there was no indication that the sponsors have abandoned their plan to make steep cuts to Medicaid through a per capita cap.
Such a move would end up cutting federal funding by tens of billions of dollars by 2026 and would mean that even with another carve-out for Alaska elsewhere in the bill, the state may end up losing money. And other states will still be hit hard.
Aides to Murkowski and Collins did not immediately comment on the revised bill.
In an interview Monday with NPR’s “Morning Edition” one of the bill’s original co-sponsors, Sen. Ron Johnson (R-Wis.), said he and Graham have warned GOP leaders that they would withhold their votes for any new budget resolution unless it gave them another chance to pass health-care legislation, a threat that could complicate the party’s efforts to advance other policy priorities if this week’s effort to repeal ACA fails.
“We’ll give ourselves that option for next year as well,” Johnson said.
But even President Trump expressed skepticism Monday about the bill’s chances of passage, blaming McCain and Collins for its expected demise in an interview on the “Rick & Bubba Show,” an Alabama-based syndicated radio program.
McCain came out against the measure on Friday, arguing that Republicans should work with Democrats to produce a bill that can attract wider support.
“You can call it what you want, but that’s the only reason we don’t have it, because of John McCain,” Trump said of efforts to repeal the 2010 health-care law, adding later, “Looks like Susan Collins and some others will vote against. So we’re going to lose two or three votes, and that’s the end of that.”
Trump did not mention Paul, whose spokesman Sergio Gor said Monday that his boss, who has raised concerns about the block-granting approach at the core of the bill, said he cannot endorse the revised version of the Cassidy-Graham bill.
Democrats, for their part, continued to rail against the measure.
In a statement Monday, House Minority Leader Nancy Pelosi (D-Calif.) said the most recent changes to the bill “only worsen the crushing costs and cruelty their bill inflicts on millions of Americans with preexisting conditions and working families everywhere.”
“Republicans must stop making a dangerous bill even worse and join Democrats for constructive bipartisan progress to improve and update Americans’ health care,” she added.
The fresh discord over a signature Republican promise added turbulence to the start of a critical week for Trump and Senate Majority Leader Mitch McConnell (R-Ky.). In addition to health care, both are watching Tuesday’s special-election primary runoff in Alabama, a high-stakes intraparty fight between establishment Republicans and conservatives that could set the tone for the midterm elections next year. GOP leaders also are expected to unveil their most detailed blueprint yet of tax cuts they hope to pass by the end of the year.
Collins, a moderate Republican who has opposed previous efforts that cut Medicaid and eased coverage requirements, said Sunday in an interview on CNN’s “State of the Union” that it was “very difficult” to envision herself voting for the Cassidy-Graham legislation. She has cited concerns about how it would affect Medicaid recipients and people with preexisting conditions, among other things.
Collins voted against a repeal bill in July, and she is a key vote in the current dynamic. She said she chatted at length with Pence on Saturday, but it wasn’t enough to sway her. She said she wants to see the limited analysis due out this week from the nonpartisan Congressional Budget Office before making a final decision.
The CBO will issue a preliminary analysis of an updated version of the bill later Monday, it announced in a blog post, though the report will address only the legislation’s fiscal impact and not its effects on the number of Americans with health coverage or on insurance premiums.
Sen. Cory Gardner (R-Colo.), whose state has expanded Medicaid, also has indicated that he needs to see the CBO analysis before taking a position on the legislation.
Other Republicans also have expressed reservations about the latest effort to unwind the ACA. Sen. Ted Cruz (R-Tex.) — a conservative who has advocated a more far-reaching repeal — said at the Texas Tribune Festival in Austin that he and at least one other conservative, Sen. Mike Lee (R-Utah), do not back the measure “right now.”
Cruz said he and Lee met with Graham and Cassidy last week to propose changes to the measure that would get them to yes. Their changes were not included in the latest draft.
Graham and Cassidy pledged to keep trying to pass their bill — but the White House and McConnell gave differing accounts of the path ahead. White House legislative affairs director Marc Short predicted a Wednesday vote, while a McConnell spokesman declined to publicly embrace that timeline.
The bill has been roundly rejected by influential national groups representing physicians, hospitals and insurers. Over the weekend, six such organizations, including the American Medical Association and the American Hospital Association, issued a joint statement urging the Senate to reject the measure.
These groups, along with others, are escalating their efforts to derail the bill. A group of patients held a rally Monday at the U.S. Capitol, to protest its effect on Americans with preexisting conditions. And the advocacy group Save My Care is airing a new six-figure ad in Washington starting Tuesday that will highlight the opposition of not just the AMA but also AARP, Medicaid directors in all 50 states, and a range of patients’ rights organizations.
Elise Viebeck and Mike DeBonis contributed to this report.