Partial health care bill expected

Off for a week, Senate Republicans still at odds on details

Senate Majority Leader Mitch McConnell, R-Ky., in Washington on May 25, 2017. Bloomberg photo by Andrew Harrer.
Senate Majority Leader Mitch McConnell, R-Ky., in Washington on May 25, 2017. Bloomberg photo by Andrew Harrer.

WASHINGTON -- Senate Republicans plan to return from a weeklong holiday recess with a partial draft of a bill to reshape the nation's health care laws. But significant and persistent divisions in their ranks have cast the prospect of passing legislation into serious doubt after weeks of discussion.

Majority Leader Mitch McConnell, R-Ky., and his top deputies have voiced uncertainty about how they will round up the 50 votes needed to pass a bill. And they have declined to give details about their emerging measure, which is expected to look different from a House-passed bill that has drawn criticism from some Republicans who say it went too far in undoing the Patient Protection and Affordable Care Act, President Barack Obama's health care law.

"I think people's staff will start putting together some language we can look at when we return," said Sen. John Cornyn of Texas, the second-ranking Republican. But he said, "There is no final agreement yet."

Others were less diplomatic about the disharmony in the effort to fulfill one of the GOP's signature campaign promises. The biggest issues yet to be resolved, according to Republican senators, include how expansively the federal government should fund Medicaid, whether to enable states to avoid key Affordable Care Act regulations and how to structure tax credits to replace federal insurance subsides offered under the current law.

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

"We're having meetings, discussions about it to the point of utter boredom every lunch that we have," said Sen. John McCain, R-Ariz. "So I think they're trying to build consensus, and there isn't consensus yet."

McConnell and the top Republicans on three committees are expected to work with staff to take the lead on crafting the measure, GOP aides said.

But what their final product will look like and when it will be ready for a vote were up in the air as senators dispersed to their home states for the one-week Memorial Day recess Thursday. With just a 52-48 advantage over Democrats, Republicans can afford only two defections. McConnell told Reuters this week "I don't know how" to get to 50 votes. And Senate Republican Conference Chairman John Thune of South Dakota offered a less-than-confident "I hope so" when asked if Republicans can get to 50.

"We need to establish firmly what our goals are," said Sen. Bill Cassidy, R-La., who has introduced a health care proposal with Sen. Susan Collins, R-Maine. "It is a little nebulous."

Despite McConnell's public push to distinguish the Senate health care effort from the secretive House process by focusing recent Republican lunches on health care and meeting with a smaller group of senators to discuss it, some critics say he is repeating the lower chamber's mistake of crafting the bill too privately.

"It's one way to go forward," Collins said. "I think it's always helpful to have some public hearings and bring in some experts."

Cassidy was among the Republican senators who attended a Senate GOP health care working group meeting Thursday. The ideologically diverse group of senators, which meets twice a week and has grown to more than 13, was designed as a testing ground for ideas and a way to educate lawmakers about the intricacies of writing a health care bill.

"We have not seen senators coming out to the press and drawing lines in the sand and saying if A, B and C aren't in the bill then I'm out," said Sen. Ted Cruz, R-Texas, one of the group's founders. "You have a whole bunch of senators doing that. That breaks the process down quickly."

Even without such pronouncements, however, the wide gaps in policy and politics among Republican senators have become apparent.

One area of disagreement is the question of whether to allow states to opt out of some current health care law regulations, such as the requirement that insurers cover people with pre-existing medical conditions and do not charge them more than healthy individuals. The House bill allows this.

Cruz said he wants to give states more flexibility in lifting some Affordable Care Act requirements on insurers to give people access to cheaper, leaner plans. But Cassidy expressed concerns that state waivers will translate into fewer benefits and trouble for those with pre-existing conditions.

The House bill has come under renewed scrutiny following a nonpartisan Congressional Budget Office analysis released this week that showed it would leave 23 million more Americans uninsured by 2026 than under current law and would force some less healthy individuals to pay more for coverage.

Democrats have united against the Republican push to repeal and replace parts of the current health care law. McConnell is not counting on winning a single crossover vote.

For some Republicans, that's problematic.

"A Republican plan to replace a Democratic plan is not what the country needs," said Sen. Lindsey Graham, R-S.C. "We need a bipartisan plan."

Asked whether there might be a health care vote before Congress' August recess, McCain responded: "Damned if I know."

"But I know this," he added. "Time is not on our side."

A Section on 05/27/2017

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