5 GOP senators now go against health bill

Rep. Raul Ruiz, D-Calif., an emergency room physician, is joined by (from left) Democratic Reps. Robin Kelly of Illinois, Judy Chu of California and Bobby Scott of Virginia during a news conference Friday in Washington on the Senate Republicans’ health care bill.
Rep. Raul Ruiz, D-Calif., an emergency room physician, is joined by (from left) Democratic Reps. Robin Kelly of Illinois, Judy Chu of California and Bobby Scott of Virginia during a news conference Friday in Washington on the Senate Republicans’ health care bill.

WASHINGTON -- Republicans' efforts to pass an expansive bill to scuttle much of former President Barack Obama's health care law met added resistance Friday when U.S. Sen. Dean Heller of Nevada declared that he could not support it as written.

Heller's opposition increases to five the number of Republican senators who say they can't support the measure -- more than enough to sink it and complicating party leaders' work to guide the legislation to a vote next week.

Heller said he opposes the measure "in this form" but did not rule out backing a version that is changed to his liking. Senate Majority Leader Mitch McConnell, R-Ky., has said he's willing to alter the measure to attract support.

Just hours after McConnell released the 142-page health-care legislation Thursday, four conservatives said they opposed it -- Sens. Ron Johnson of Wisconsin, Mike Lee of Utah, Rand Paul of Kentucky and Ted Cruz of Texas.

[DOCUMENT: Read text of full bill]

Sen. John Cornyn, the No. 2 Republican leader, said he was still confident that at least 50 of the chamber's 52 Republicans will wind up supporting it in a vote likely to come early Friday. To pass the measure will require 50 votes of senators and the tie-breaking vote of Vice President Mike Pence.

The plan released Thursday "is sort of a best guess of where the Republican conference is," Cornyn told reporters, adding that McConnell will massage its contents right up until he introduces it, as early as Tuesday.

Besides the five who announced outright opposition, several other GOP senators -- conservatives and moderates -- have declined to commit to the overhaul. The measure resembles legislation the House approved last month that the nonpartisan Congressional Budget Office said would mean 23 million additional uninsured people within a decade and that recent polling shows is viewed favorably by only around 1 in 4 Americans.

Arkansas' two U.S. Sens. John Boozman and Tom Cotton, were among those saying Friday that they haven't decided yet whether they'll support the Senate version of the American Health Care Act.

[INTERACTIVE: Compare new health care bill with Affordable Care Act]

"I've got some concerns about it," Boozman said.

The Republican from Rogers declined to identify any of the provisions that have caused him concern. "We're still looking at it, to be honest, and what I don't want to do is negotiate openly," he said.

He predicted that the legislation will continue to evolve.

"This is a draft. I think it'll be changed next week, and so we'll just have to wait and see what the final bill looks like," he said.

Action is needed, he said. "The system that we've got now is broken," Boozman said, pointing to the rise in premiums Arkansans have faced since the Obama health care law began.

Lawmakers "want to make sure that those that genuinely need help are taken care of," he said.

Cotton called the Senate draft "a constructive first step," but said he couldn't yet determine whether it is an improvement over the version that House Republicans passed.

"I'm obviously going to spend the weekend reviewing it carefully, reviewing all the implications of it and we'll see if it's something I can support or something that I can support if we get a few changes to it," he said.

Cotton, a Republican from Dardanelle, said current health care law is collapsing and changes are needed. "I want to make sure that the legislation we pass is going to make health care a little bit more affordable and a little bit better for Arkansans," he said.

Medicaid provisions

Heller, facing a competitive re-election battle next year, said he was opposing the legislation because of the cuts it would make in Medicaid. The federal-state program provides health care to the poor, disabled and many nursing home patients.

The Senate legislation would phase out extra federal money that Nevada and 30 other states, including Arkansas, receive for expanding Medicaid to additional low-wage earners. It would also put annual spending caps on the overall Medicaid program, which since its inception in 1965 has provided states with unlimited money to cover eligible costs.

Arkansas' expansion of Medicaid covered 316,603 people as of May 31, according to state figures released Thursday.

"I cannot support a piece of legislation that takes insurance away from tens of millions of Americans and tens of thousands of Nevadans," Heller said.

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Heller said that to secure his support for the measure, GOP leaders would have to "protect Medicaid expansion states" from the bill's current cuts.

"It's going to be very difficult to get me to a yes," he said, noting that conservative Republican senators would likely be reluctant to add spending back into the measure.

Heller spoke at a news conference in Las Vegas with Nevada Gov. Brian Sandoval, a Republican who has also assailed the House and Senate health care bills for cutting Medicaid. That state added 200,000 people to its program under the Obama overhaul.

Sandoval said the Senate bill "is something that needs to change."

Several other Republican governors also expressed reservations about the bill.

John Kasich of Ohio, Charlie Baker of Massachusetts and Larry Hogan of Maryland issued separate statements criticizing aspects of the legislation, including the secrecy under which it was written, and the impact it would have on state budgets and low-income residents.

All four governors are in states that expanded Medicaid under the Patient Protection and Affordable Care Act and have received billions of federal dollars to help them cover more low-income Americans.

But at least one Republican governor of a Medicaid-expansion state signaled that he felt the bill was a step in the right direction. Gov. Asa Hutchinson of Arkansas said in a statement that more time is needed to gauge the measure's potential impact but "there are significant positive changes in the Senate bill, including increased flexibility for the states."

Hutchinson is seeking permission from the Trump administration to make conservative adjustments to the program in Arkansas, including instituting a work requirement for many enrollees.

Pressure planned

There has been little in the way of advertising from conservatives pushing Republicans to support the bill. But Heller's criticism Friday infuriated allies of Trump.

America First Policies, a super PAC aligned with the White House, was gearing up to spend $1 million on advertising in Nevada aimed at making the senator change his mind, according to a person familiar with the group's plans.

Heller's quick denunciation offered a morale boost for Democrats after they received recriminations about why their party lost in Tuesday's special congressional election in Georgia.

"It's an all-hands-on-deck moment," said Anna Galland, the head of MoveOn.org, an advocacy group on the liberal wing of the party. "We are unified out of urgent, building-is-burning-down necessity. And health care is by far our top priority."

Even Hillary Clinton, who has become increasingly outspoken after a period of postelection restraint, blasted it on Twitter: "Forget death panels. If Republicans pass this bill, they're the death party."

Scrambling to halt or at least slow the Senate's repeal effort, a range of Democratic and liberal groups leaders said Friday that they intended to intensify pressure on Republican lawmakers.

Liberal groups have already organized protests against the bill, and Sen. Bernie Sanders, I-Vt., plans to lead a campaign-style tour this weekend through West Virginia, Pennsylvania and Ohio -- three states with Republican senators that also expanded Medicaid under the Affordable Care Act.

Planned Parenthood, which would be defunded under the Senate bill, has been running television ads targeting Heller, as well as Sens. Jeff Flake, R-Ariz., who also is up for re-election next year, and Shelley Moore Capito, R-W.Va.

Democrats believe that the coming week represents their best and perhaps final chance to thwart repeal of the Obama health care law.

"This is the one opportunity we have to shine a light on this legislation, and we will do it day and night," said Sen. Chris Van Hollen, D-Md.

The Senate Democratic campaign arm, which Van Hollen leads, plans to increase its spending this week on Internet ads focused on the health measure in Nevada and Arizona, as well as in Texas and Florida, which also have Senate races in 2018.

The Democratic Senatorial Campaign Committee is just one of a series of liberal groups airing spots to pressure Senate Republicans, who face re-election next year, into opposing the overhaul.

Information for this article was contributed by Alan Fram, Regina Garcia Cano and Thomas Beaumont of The Associated Press; by Laura Litvan, Steven T. Dennis, Sahil Kapur and Nathan Howard of Bloomberg News; by Sandhya Somashekhar, Sean Sullivan, Robert Costa and Kelsey Snell of The Washington Post; by Jonathan Martin, Alexander Burns and Maggie Haberman of The New York Times; and by Frank E. Lockwood and staff members of the Arkansas Democrat-Gazette.

A Section on 06/24/2017

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Terrie Root (right) of Little Rock leads a chant Friday at Sen. Tom Cotton’s Little Rock office. About 50 demonstrators, organized by Indivisible Little Rock and Central Arkansas, gathered at the Victory Building on West Capitol Avenue to protest the Senate’s proposed health care legislation, which Cotton had a hand in writing. Building security limited the number of protesters in the small lobby to about 10 at a time.

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AP/Las Vegas Review-Journal/ ERIK VERDUZCO

Sen. Dean Heller, R-Nev., announces Friday in Las Vegas that he will vote no on the GOP’s proposed health care bill.

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