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Vote Delayed as Republicans Struggle to Marshal Support for Health Care Bill Vote Delayed as G.O.P. Struggles to Marshal Support for Health Care Bill
(about 4 hours later)
WASHINGTON — Facing intransigent Republican opposition, Senator Mitch McConnell of Kentucky, the Republican leader, announced on Tuesday that he will delay a vote on his legislation to repeal the Affordable Care Act, dealing President Trump an embarrassing setback on a key part of his agenda. WASHINGTON — Facing intransigent Republican opposition, the Senate majority leader, Mitch McConnell, on Tuesday delayed a vote on legislation to repeal the Affordable Care Act, dealing another setback to Republicans’ seven-year effort to dismantle the health law and setting up a long, heated summer of health care battles.
Republican leaders had hoped to take a page from the playbook used to get a bill over the line in the House, appeasing the most conservative members of their conference while pressuring moderates to fall in line with fewer concessions. Mr. McConnell faced resistance from across his conference, not only from the most moderate and conservative senators but from others as well. Had he pressed forward this week, he almost surely would have lacked the votes even to begin debate on the bill.
But as opposition mounted in both camps, even against a vote just to take up the bill, Mr. McConnell decided he would delay consideration until after the Senate’s weeklong July 4 recess. “We will not be on the bill this week, but we’re still working toward getting at least 50 people in a comfortable place,” said Mr. McConnell, who is known as a canny strategist but was forced to acknowledge on Tuesday that he had more work to do.
“We will not be on the bill this week, but we will still be working to get at least 50 people in a comfortable place,” Mr. McConnell said. The delay pushes Senate consideration of the bill until after a planned recess for the Fourth of July, but it does not guarantee that Republican senators will come together. Opponents of the bill, including patient advocacy groups and medical organizations, plan to lobby senators in their home states next week. Senators are likely to be dogged by demonstrators. Democrats vowed to keep up the pressure, and some Republican senators have suggested that their votes will be difficult to win.
That delay does not guarantee the senators will come together. Opposition groups will mount pressure campaigns on lawmakers in their home states, and policy divisions are deep. After meeting with President Trump at the White House, Mr. McConnell told reporters that if Republicans could not come to an agreement, they would be forced to negotiate a deal with Senator Chuck Schumer of New York, the Democratic leader.
“It’s hard to see how tinkering is going to satisfy my personal concerns,” Senator Susan Collins, Republican of Maine, told reporters. “The status quo is simply unsustainable,” Mr. McConnell said. “It’ll be dealt with in one of two ways: Either Republicans will agree and change the status quo, or the markets will continue to collapse, and we’ll have to sit down with Senator Schumer. And my suspicion is that any negotiation with the Democrats would include none of the reforms that we would like to make.”
Negotiations on Tuesday that leaders hoped would move senators toward yes only exposed the fissures in the Republican Party. Conservatives were demanding that states be allowed to waive the Affordable Care Act’s prohibition on insurance companies charging sick people more for coverage and are asking for a more expansive waiver system for state regulators. They also wanted more money for tax-free health savings accounts to help people pay for private insurance. Republicans have promised for seven years to repeal the health law, President Barack Obama’s signature domestic achievement. But Mr. McConnell’s announcement on Tuesday was yet another major stumble in the unsteady quest by Republican congressional leaders to deliver a repeal bill to the desk of Mr. Trump, who has yet to sign his first piece of marquee legislation.
Senators from states that expanded the Medicaid program — and Senator Susan Collins — would not brook many of those changes, especially the measure to severely undermine protections for people with pre-existing medical conditions. They wanted more money for mental health benefits for people addicted to opioids and money for states to cover people left behind by the rollback of the Medicaid program in both the House and Senate versions. Mr. McConnell, the chief author of the Senate repeal bill, can afford to lose only two of the 52 Republican senators, but more than a half-dozen have, for widely divergent reasons, expressed deep reservations about the bill.
Three Republican senators — Ms. Collins, Rand Paul of Kentucky and Ron Johnson of Wisconsin — had announced they would vote against the motion to begin debate that had been scheduled to hit the Senate floor on Wednesday, joining Senator Dean Heller of Nevada, who made the same pledge on Friday. Mr. Trump, meeting with Republican senators at the White House, declared, “We’re getting very close.”
A bevy of other senators from both flanks of the party seemed headed in the same direction if they did not see changes made to the Senate health care bill, leaving the measure in deep peril, since Republicans can only lose two votes from their own party. “This will be great if we get it done,” he said. “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 O.K., and I understand that very well.”
The release of a Congressional Budget Office evaluation on Monday did little to help leaders roll up votes from either side of the fence. The budget office said the Senate bill would leave 22 million more uninsured after 10 years, while sending out-of-pocket medical expenses skyrocketing for the working poor and those nearing retirement. Mr. McConnell wrote his bill behind closed doors, betting he could fashion a product that would show significant improvement over the bill that was narrowly approved by the House last month. And he laid out an aggressive timeline for its passage, hoping to secure Senate approval roughly a week after unveiling the legislation.
The budget office did not provide conservatives with support for their demands either. The state waivers already in the Senate bill “would probably cause market instability in some areas” and “would have little effect on the number of people insured” by 2026, the analysis concluded. Adding still more waivers, including one that could allow insurers to price the sick out of the health care market, could deprive even more people of health care. Yet on Tuesday, just five days after releasing the bill, Mr. McConnell had to bow to reality: Republican senators were not ready to move ahead with the bill.
Even before Mr. McConnell’s decision, White House officials had braced for the likelihood that the procedural vote would fail and that they would have to revisit the measure after the Fourth of July recess — when they hoped to be able to woo Mr. Johnson, who has been a surprisingly fierce critic of the bill from the right. The senator has repeatedly warned that this week is too soon to vote on the health care measure, as Republican senate leaders have insisted they need to do. At least a small number might never be — raising questions about whether Mr. McConnell will be able to win over the votes for passage.
Vice President Mike Pence, attended the Senate Republican lunch on Tuesday and then broke off for private meetings with Mr. Heller, a seemingly firm “no” and the first moderate Republican to break with Mr. McConnell over the bill, and Rob Portman of Ohio, who is feeling pressure from his state’s governor, John R. Kasich, to oppose the bill and defend Ohio’s Medicaid expansion. “It’s difficult for me to see how any tinkering is going to satisfy my fundamental and deep concerns about the impact of the bill,” said Senator Susan Collins, Republican of Maine, who was among the lawmakers prepared to vote against taking up the bill this week.
Mr. Portman was the subject of a spirited evaluation of his open criticism of the bill by Mr. McConnell, who was frustrated with the expansion-state senators who showed their hand early to other wavering colleagues, dooming the bill for now. Mr. McConnell was unhappy that Mr. Portman seemed to be abandoning his previous stance on fiscal rectitude by opposing Medicaid cuts in the bill. Mr. McConnell and his leadership team are hoping to replicate the feat of Speaker Paul D. Ryan, who revived the House’s repeal bill and pushed it to passage six weeks after it appeared to be dead.
But the Ohio senator was getting it from both sides. Mr. Kasich appeared in Washington on Tuesday to sharply criticize the Senate bill. The governor said he was deeply concerned about millions of people losing coverage under the bill. “I would hope, by the end of the week, that we have reached basically a conclusion with regard to the substance and the policy of this,” said Senator John Thune of South Dakota, a member of the Senate Republican leadership.
“Who would lose this coverage?” Mr. Kasich said. “The mentally ill, the drug addicted, the chronically ill. I believe these are people that need to have coverage.” Then, he said, it is just a question of timing.
At the same news conference, Colorado’s Democratic governor, John W. Hickenlooper, said his state’s Republican senator, Cory Gardner, “understands the hardships and the difficulties in rural life.” Democrats are unified against the repeal bill, but they were not celebrating on Tuesday.
“This bill would punish people in rural Colorado,” Mr. Hickenlooper said, raising the pressure. “The mantra on our side is never to underestimate Mitch McConnell,” said Senator Richard Blumenthal, Democrat of Connecticut.
Doctors, hospitals and other health care provider groups came out strongly against the Senate bill, as did patient advocacy groups like the American Heart Association. But business groups were ramping up their support. In a letter on Tuesday, the U.S. Chamber of Commerce endorsed the Senate bill and urged senators to vote for it. Mr. Schumer said: “We know the fight is not over. That is for sure.” Over the next few weeks, he said, Mr. McConnell “will try to use a slush fund to buy off Republicans, cut back-room deals, to try and get this thing done.”
At least four Republican senators — Ms. Collins, Dean Heller of Nevada, Ron Johnson of Wisconsin and Rand Paul of Kentucky — had said they would vote against the motion to begin debate, enough to ensure it would fail. Other Republicans also appeared reluctant about moving forward with the bill.
“I’m just grateful leadership decided, let’s take our time, give this more thought and try and get this right,” said Mr. Johnson, who had been critical of the desire by Republican leaders to hold a vote this week.
After Mr. McConnell’s announcement, three other Republicans announced their opposition to the bill in its current form: Jerry Moran of Kansas, Shelley Moore Capito of West Virginia and Rob Portman of Ohio.
Ms. Capito and Mr. Portman, who announced their opposition together, expressed concern about how the bill would affect Medicaid and the opioid crisis, which has had devastating effects in their states.
The release of a Congressional Budget Office evaluation on Monday made it much more difficult for party leaders to win over hesitant Republican members. The budget office said the Senate bill would leave 22 million more people uninsured after 10 years, and many people buying insurance on the individual market would have skimpier coverage and higher out-of-pocket costs.
The Senate Democratic whip, Richard J. Durbin of Illinois, said the report by the Congressional Budget Office “did more to strike a dagger to the heart of this Republican repeal than anything else.”
In 2026, the budget office said, 15 million fewer people would have Medicaid coverage under the Senate bill than under the Affordable Care Act, and seven million fewer people would have coverage they purchased on their own. Faced with deep cuts in Medicaid, the report said, state officials would face unpalatable choices: restrict eligibility, eliminate services, reduce payments to health care providers and health plans, or spend more of their own money.
Appearing in Washington, Gov. John R. Kasich of Ohio cited the 22 million projection and expressed bewilderment that fellow Republicans would be on board with the bill.
“And they think that’s great?” he asked. “That’s good public policy? What, are you kidding me?”
Doctors, hospitals and other health care provider groups have come out strongly against the Senate bill, as have patient advocacy groups like the American Heart Association. But business groups were ramping up their support. In a letter on Tuesday, the U.S. Chamber of Commerce urged senators to vote for the bill.
The Senate bill “will repeal the most egregious taxes and mandates” of the Affordable Care Act, allowing employers to create more jobs, said Jack Howard, a senior vice president of the group. The bill, he noted, would repeal a tax on medical devices and eliminate penalties on large employers that do not offer coverage to employees.The Senate bill “will repeal the most egregious taxes and mandates” of the Affordable Care Act, allowing employers to create more jobs, said Jack Howard, a senior vice president of the group. The bill, he noted, would repeal a tax on medical devices and eliminate penalties on large employers that do not offer coverage to employees.
A separate letter expressing general support for the Senate’s efforts was sent by a coalition of 28 business and employer groups including the National Association of Home Builders, the National Restaurant Association and the National Retail Federation. A separate letter expressing general support for the Senate’s efforts was sent by a coalition of business and employer groups including the National Association of Home Builders, the National Restaurant Association and the National Retail Federation.
But Senate conservatives found themselves squeezed between business sentiment and their conservative base. Club for Growth, an ardently conservative political action committee, came out strongly against the Senate measure on Tuesday. But Senate conservatives found themselves squeezed between business sentiment and their conservative base. The Club for Growth, a conservative group, came out against the Senate measure on Tuesday. The organization’s president, David McIntosh, noted that congressional Republicans had “promised to repeal every word” of the Affordable Care Act.
“The Club for Growth and the American people took Republicans in Congress at their word when they promised to repeal every word – ‘root and branch’ – of Obamacare and replace it with a patient-centered approach to health care,” the group’s president, David McIntosh, said in a statement. “Only in Washington does repeal translate to restore. Because that’s exactly what the Senate GOP healthcare bill does: it restores Obamacare.” “Only in Washington does repeal translate to restore,” he said. “Because that’s exactly what the Senate G.O.P. health care bill does: It restores Obamacare.”
Even the Trump administration is divided over what comes next, especially on the payment of subsidies to health insurance companies to compensate for reducing out-of-pocket costs for low-income people.
Mr. Trump has threatened to withhold the monthly payments as a way to induce Democrats to bargain with him over the future of the Affordable Care Act. Administration officials said Mr. Trump did not want to make the payments if the Senate did not pass a health care bill this week. But they said Tom Price, the secretary of health and human services, had urged the White House not to cut off the payments abruptly.
A federal judge has ruled that the payments are illegal because Congress never appropriated money for them, but that ruling is being appealed. Any interruption of the payments could have a dire destabilizing effect on markets, insurers say. Blue Cross Blue Shield of North Carolina recently blamed the Trump administration’s mixed signals on the subsidy for most of its proposed 23 percent spike in premiums next year.
Sean Spicer, the White House press secretary, defended the administration’s position at his briefing on Friday.
“If the president were to hypothetically say that he’s going to make the payments in perpetuity or for a year, I think that continues to prop up a failed system,” Mr. Spicer said. “It continues to do wrong by the American taxpayer. And it also doesn’t lend itself to the expediency that I think we want to — help get a new health care system in place.”