âEvery Republican is trying to get to yes,â Senator John Barrasso of Wyoming, a member of the Senate Republican leadership, said Monday on Fox News, expressing his belief that the Senate would vote on a repeal bill before the recess. He acknowledged that âthere are some differences of opinion on specific details of this.â
If Republicans do not hold a vote before the Fourth of July, Democrats hope the pressure over the recess will weaken support. Then lawmakers would have just three weeks to pass a Senate bill and work out differences with the House before the planned August recess. The Trump administration also wants Congress to raise the governmentâs statutory borrowing limit before August, another fight that could collide with the Affordable Care Act repeal.
âIf Republicans wonât relent and debate their health care bill in the open for the American people to see, then they shouldnât expect business as usual in the Senate,â said Chuck Schumer of New York, the Senate Democratic leader.
He said the actions planned by Senate Democrats, such as procedural maneuvers to slow down routine work, were âmerely the first steps weâre prepared to take in order to shine a light on this shameful Trumpcare bill.â
Republicans are working on their bill as insurers around the country are announcing their intentions for 2018. On Monday, the last major insurer remaining in Iowa said it planned to stay in the Affordable Care Actâs marketplace next year. The insurer, Medica, said that it expected to offer plans statewide, even after two competitors said they would pull out, but that it was seeking rate increases averaging 43.5 percent.
âIowaâs individual market remains unsustainable and needs a fix from Congress,â said the stateâs insurance commissioner, Doug Ommen.
Republicans, who hold 52 seats in the Senate, are planning to pass their repeal bill using special budget rules that would bypass a Democratic filibuster. But they can afford to lose only two votes, with Vice President Mike Pence breaking a tie, and more than two Republican senators have expressed qualms, from moderates like Susan Collins of Maine and Lisa Murkowski of Alaska to conservatives like Rand Paul of Kentucky and Mike Lee of Utah.
So far, Republican senators have been unable to reach a consensus on a repeal bill, facing internal divisions over issues like the future of the expansion of Medicaid under the Affordable Care Act, the rate at which Medicaid payments to states would grow in future years and federal funding for Planned Parenthood.
In impassioned speeches on the Senate floor on Monday night, Democrats complained that the bill was being developed out of public view. Before Congress adopted the Affordable Care Act, Democrats held numerous public hearings, and the Senate debated the measure on the floor for 25 days.
Senate Republican leaders plan to push through their repeal bill under arcane budget rules that would limit debate on it to 20 hours.
On the Senate floor on Monday, Mr. Schumer asked the Senate majority leader, Mitch McConnell of Kentucky, if senators would have more than 10 hours to review the Senate bill before voting on it. Mr. McConnell said only that there would be âample opportunity to read and amend the bill.â
The opaque process playing out now has drawn criticism not only from Democrats, but also from some Republican senators.
âI think itâs much better to have committee consideration of bills, public hearings and to have a full debate,â Ms. Collins told The Portland Press Herald on Friday. âThatâs the process for most well-considered legislation.â
Democrats, meanwhile, have been pressing the issue, pushed by liberal advocacy groups that are demanding a more confrontational approach.
Last week, Mr. Schumer sent a letter to Mr. McConnell inviting Republicans to an all-senators meeting on health care. Mr. McConnell did not take him up on the offer.
On Monday, in a jab at Republicans for proceeding without any public hearings on their bill, Senate Democrats released a letter to Republican committee leaders in which they helpfully provided a list of rooms in the Capitol complex that could be used to hold hearings.
A coalition of groups representing patients said they had been rebuffed when they requested a meeting in Washington with Mr. McConnell.
Sue Nelson, a vice president of the American Heart Association, said on Monday that her organization had requested the meeting on behalf of more than a dozen patient advocacy groups. They were told that the majority leader was too busy, she said.
Don Stewart, a spokesman for Mr. McConnell, said the senator and his staff had met with numerous groups representing patients, doctors and hospitals, especially those in Kentucky, and would continue to do so. âThe notion that we are not meeting with patient groups is ridiculous,â he said.
Senate leaders have refrained from going into detail about the bill they are drafting, but some provisions being considered have become known in recent days.
The Senate bill would give states sweeping new authority to opt out of federal insurance standards established by the Affordable Care Act, congressional aides said. In that way, it appears to go further than the House-passed bill in giving states latitude to regulate their health insurance markets.
It builds on a section of the Affordable Care Act that allows states to obtain waivers for innovative health programs. But it would relax many of the requirements for such waivers that Democrats wrote into the law, signed by President Barack Obama in 2010.
Republican senators are still discussing exactly which standards could be waived. Many Republicans want to allow states to prescribe a more limited, less expensive package of health benefits than is required under the Affordable Care Act. Republicans disagree on whether states should be able to allow insurers to set higher premiums for some people with pre-existing conditions.
A Democrat, Senator Ron Wyden of Oregon, proposed âinnovation waiversâ in 2007, to allow states to find their own ways to near-universal coverage.
âThe point was to say that the states, the laboratories of democracy, would have an opportunity to show that they could do better than the Affordable Care Act,â Mr. Wyden said. Republicans, he said, want âto use the waiver process so that states could do not better, but worse.â