Republican Senator Ron Johnson accused Majority Leader Mitch McConnell of “a real breach of trust” by telling some Republicans privately that long-term cuts conservatives demanded to Medicaid provisions of the party’s embattled health-care bill are unlikely to ever take effect.
With two Republicans already opposed to advancing the measure, McConnell can’t afford to lose another senator. Johnson, who had previously said he supported the bill, said other senators told him about McConnell’s comments.
"That’s troubling to me," the Wisconsin Republican told reporters. "I was strongly in favor" of advancing the bill last week but is no longer urging his colleagues to do so, he said.
Johnson’s remarks are the latest setback for Republicans’ efforts to repeal Obamacare. McConnell had to delay a planned vote by at least a week after Senator John McCain announce he would be home in Arizona this week, recovering from unexpected surgery.
Senate Republicans are also anxiously awaiting a key analysis of their revised health bill, which is expected sometime this week. Several Republican senators visited the White House late Monday for a meeting on the measure.
Johnson, who didn’t participate in the White House meeting, said he was angry over McConnell’s alleged remarks about a controversial provision in the Senate health care bill that would, starting in 2025, cap Medicaid spending growth at the rate of regular inflation, which for many years has been lower than the rate of medical inflation.
McConnell issued a statement late Monday defending the inclusion of the spending cap.
“I prefer to speak for myself, and my view is that the Medicaid per capita cap with a responsible growth rate that is sustainable for taxpayers is the most important long-term reform in the bill,” he said. “That is why it has been in each draft we have released.”
The far-reaching change would be the most significant Medicaid cut since its inception in 1965; the program has thus far been authorized to spend flexibly on a need-based basis. Many conservatives support that change to rein in long-term federal spending, but some moderate Republicans, including Senator Rob Portman of Ohio, worry that it would hammer their Medicaid populations.
"It’s one of the concerns I’ve expressed consistently," Portman said Monday night. "Still having discussions, still trying to improve the bill."
McConnell has some extra time to negotiate, given the latest delay, sparked by McCain’s surgery to remove a blood clot from above his left eye.
“While John is recovering, the Senate will continue our work on legislative items and nominations, and will defer consideration of the Better Care Act,” McConnell said in a statement late Saturday.
Republican Senator Lindsey Graham said Monday that McCain is “going to be A-okay."
“He needs to wait a week. He wants to come back so bad he can’t stand it,” Graham told reporters. “I think he can’t fly for a week. I think he would walk back if they would let him.”
In the meantime, McConnell has to win over a number of holdouts, including Portman, Shelley Moore Capito of West Virginia, Lisa Murkowski of Alaska and Dean Heller of Nevada.
The legislation is "in a holding pattern right now," said Senator Susan Collins of Maine, who came out against his proposal shortly after the revised version was released on Thursday. "I think there are 8-10 Republicans with concerns."
The Congressional Budget Office is expected to soon issue its estimate of the new plan’s impact on health coverage and the federal budget deficit, although not on Monday, as many had anticipated. Regardless of the timing, Republicans hope the report will look better than an earlier version, which said the Republican plan would cause 22 million Americans to lose insurance by 2026.
It’s not guaranteed, though, that the fresh analysis will show dramatically better effects. It’s also not expected to include a full accounting of a new provision, pushed by Republican Senators Ted Cruz of Texas and Mike Lee of Utah, that would allow cheaper health plans free of Obamacare regulations on what elements need to be covered. That assessment could take several weeks, a Senate Republican aide said.
McConnell is struggling to find a path to deliver on seven years of Republican promises to repeal Obamacare. So far, despite strong pressure from President Donald Trump, the middle ground that can win over moderates without alienating conservatives has proven elusive.
The fight for passage “does get worse” for McConnell because of the delay, Senator Debbie Stabenow, a Michigan Democrat who opposes the bill, said Monday on MSNBC. She cited a letter from the Blue Cross Blue Shield Association that criticized the addition of the amendment backed by Cruz and Lee allowing insurers to sell plans that don’t cover pre-existing conditions. “It adds junk insurance plans,” she said.
Groups including MoveOn.org, the Indivisible Project and Planned Parenthood said McCain’s delayed return to Washington is a boon to their effort to keep the Affordable Care Act in place. They’re planning sit-ins at GOP senators’ offices, rallies in their home states and phone calls to offices of key holdouts such as Murkowski and Heller.
“The delay due to McCain’s condition is a huge injection of the greatest resource to the resistance movement, which is more time,” said Ben Wikler, Washington director of MoveOn.
The most pressing obstacle Republican leaders face appears to be demands by several moderates to restore funding for Medicaid that would be cut under the Obamacare repeal measure. There is also significant pushback to the Cruz-Lee amendment, which health specialists warn may destabilize insurance markets.
McConnell’s latest draft bill would add $70 billion more for state stability and innovation funds, leave intact Obamacare tax increases on the wealthy, and put $45 billion toward addressing the opioid epidemic.
McConnell’s initial challenge is to get all the remaining holdouts to agree not to vote with Democrats to block the measure from reaching the floor for debate.
Winning Over Conservatives
With their latest version, Republican leaders seemed to shore up support from conservatives, largely by including a version of the Cruz-Lee amendment that would allow insurers to sell skimpier plans and bar people with pre-existing conditions. Still, that language risks being stricken out by a parliamentary challenge under the filibuster-busting procedures McConnell is using.
Lee said last week he’s still reviewing it but is unhappy that it’s different than what he proposed. If the provision is dropped out altogether, whether by parliamentary challenge or another method, support of both senators and others could drop off.
Meanwhile, Republican governors from states of GOP holdouts have significant sway. Ohio Governor John Kasich on Friday blasted the revised bill as “unacceptable,” which could make it tougher to bring Portman on board.
“Its cuts to Medicaid are too deep and at the same time it fails to give states the ability to innovate in order to cope with those reductions,” Kasich said in a statement. “It also doesn’t do enough to stabilize the insurance market, where costs are rising unsustainably and companies are simply dropping coverage.”
McConnell also has to win over Murkowski, who’s voiced concerns about the plan’s impact on subsidies for consumers on Obamacare’s insurance exchanges, Medicaid cuts, and its one-year ban on funding for Planned Parenthood.
Changes in the revised bill would send hundreds of millions of extra federal dollars to Alaska, which may help persuade her. Alaska is the only state that can benefit from formulas that would steer extra Obamacare exchange market stabilization dollars to high-premium states.
Sullivan, the state’s junior senator, said that the provision and expanded state waiver authority were positive steps, even as Murkowski remained silent.
"Everybody’s working hard over the weekend to get to yes," Sullivan said.
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