- The Washington Times - Thursday, July 20, 2017

Senate Republican leaders plowed ahead with plans to put Obamacare in the rearview mirror by August but faced even longer odds Thursday, reeling from Sen. John McCain’s cancer diagnosis and budget estimates that said 22 million fewer people would hold insurance under their revised replacement plan.

Senate Majority Leader Mitch McConnell, Kentucky Republican, wants to take up the House-passed health care bill Tuesday, setting the stage for amendments and final passage before Congress leaves for its August recess.

Mr. McCain’s absence is pivotal because leaders will not be able to proceed if more than one Republican defects. Without the Arizona Republican, the party’s majority is reduced in the Senate from 52 to 51.

“The fight to move beyond the status quo of Obamacare was certainly never going to be easy, but we’ve come a long way,” Mr. McConnell said. “I look forward to continuing our work together to finally bring relief.”

Yet Senate Republicans haven’t settled on a path forward. Some want to forge ahead with a replacement bill while others want to revive a 2015 “repeal then replace” plan that President Obama vetoed but President Trump would sign now, even if the two-step strategy would sow uncertainty in the insurance markets.

Both proposals appeared to lack sufficient support, though leaders are tweaking the replacement plan in an effort to bring more Senate Republicans on board after the push fell apart earlier in the week.

Still others want to let the states decide what to do with their Obamacare money or start over with an open committee process that involves Democrats.

Some Republican holdouts want to know which option will lead the pack before voting to proceed, but Senate Majority Whip John Cornyn of Texas told reporters that is a “luxury we don’t have.” Leaders say it’s important to get onto the bill and debate it openly during the marathon session of amendments that accompany the budget process Republicans are using to carve out Democrats.

“Their ultimate protection is to withhold their vote on the final product,” Mr. Cornyn, Texas Republican, said of skittish Republicans. “Rather than do that on the front end, my hope is they decide to proceed to debate the bill, amend it and then we can continue to work toward a 50-senator consensus on what the final vote will be.”

Mr. Trump would still like to replace Obamacare, yet the Congressional Budget Office on Thursday said the latest Republican plan would increase the number of uninsured Americans by 15 million in 2018 compared with Obamacare. The figure rises to 22 million by 2026. That eye-popping figure hasn’t changed since June, when the CBO said a previous version of the bill would result in the same number losing coverage, spooking moderate Republicans.

“The latest CBO report makes clear (once again): No amount of tweaks, modifications or giveaways Senate Republicans make or add to their health care bill can change the fact that the bill is rotten at its core and would leave millions of Americans worse off,” said Senate Minority Leader Charles E. Schumer, New York Democrat.

A poll from the Associated Press-NORC Center for Public Affairs Research says 62 percent of people think it is the federal government’s responsibility to ensure that all Americans have health care coverage, while 37 percent say it’s not.

Sen. Rand Paul, Kentucky Republican and pivotal holdout, said the replacement plan maintains too big of a federal role. He said if leaders promise to put a “clean repeal” vote on equal footing with other ideas, he would likely vote to proceed onto the bill and amendment process.

“I think the major proposals could be put at the very front. We debate them on the first day,” Mr. Paul said.

He said Senate leaders could draw lots to set the order of votes on the 2015 repeal, the replacement plan and other leading ideas, such as a bill by Sens. Susan M. Collins of Maine and Bill Cassidy of Louisiana that would let states decide whether to keep Obamacare or opt into a more conservative model.

The chaotic push toward a resolution follows a topsy-turvy week. Four Senate Republicans opposed proceeding with a replacement bill late Monday, and a trio objected Tuesday to taking up Mr. McConnell’s Plan B — the straight repeal measure from 2015. On Wednesday, Mr. Trump urged Senate Republicans to revive their replacement bill during a face-to-face lecture at the White House.

The revised replacement plan includes $70 billion more to help fund state health care reforms and another $45 billion to aid the opioid crisis, yet would save $420 billion over the coming decade.

CBO analysts said premiums would rise at first under the bill as written, mainly because the mandate requiring healthy people to join the market would be scrapped, though rates would be 25 percent lower than under Obamacare for popular “benchmark” plans by 2026 — in part because policies would be skimpier.

The CBO score released Thursday did not include an amendment that Sen. Ted Cruz, Texas Republican, proposed to let insurers sell plans that don’t comply with Obamacare’s coverage regulations, so healthier consumers could pay much less for skinnier coverage. The Health and Human Services Department released a report Wednesday that said the amendment would have positive effects, though relying on that report instead of a CBO score would be an unusual break from tradition.

Meanwhile, some moderate Republicans are still worried about deep cuts to the Medicaid program, saying they will burden their states’ budgets or leave constituents out in the cold.

Republicans are holding private meetings in efforts to make progress.

One new idea involves using funds from two Obamacare taxes on high earners to bolster states that expanded Medicaid insurance for the poor under Mr. Obama. The Republican plan would gradually phase out federal funding for the expansion through the middle of the next decade, unnerving some moderates.

An influx of funding could mollify some of them, but conservatives say they should be focused on policy changes instead.

“I’m concerned we’re throwing money at the problem,” said Sen. Ron Johnson, Wisconsin Republican. “That’s not what I want to see.”

Sally Persons contributed to this report.

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