It’s decision time for Senate Republicans’ years-long quest to repeal Obamacare.
Senate Majority Leader Mitch McConnell of Kentucky will hold a series of consequential meetings Tuesday that are expected to deliver a frank assessment of whether the divided Republican Conference can overhaul the law with their narrow majority.
Senate Republicans can lose only two votes and still repeal and replace the law via a fast-track process that sidesteps Democratic filibusters. McConnell and his leadership team hope to have a preliminary framework submitted to the Congressional Budget Office by the end of the week and a floor vote by month’s end, Republican sources said.
"We have to act. Otherwise more Americans will be stuck paying the price of Obamacare’s continuing failures," McConnell said on Tuesday.
Yet a number of Republicans have been pessimistic about the effort over the past month. And rank-and-file senators are keeping expectations low.
"You’ll have to ask leadership on that. We still have a ways to go," said Sen. Jeff Flake of Arizona on Tuesday morning of leaders’ aggressive timeline. "We’re still a ways off."
A 13-member working group huddles first Tuesday to review the party’s progress; then the entire conference gathers for lunch, where McConnell will take the GOP’s temperature on the party’s healthcare principles.
After speaking to reporters at their weekly press conference, McConnell and party whip John Cornyn of Texas head to the White House for a meeting with President Donald Trump and House GOP leaders. Many GOP senators believe the House bill to gut Obamacare, which was jammed through last month, contains Medicaid cuts that are too severe and does not do enough to lower premiums.
Medicaid has been the thorniest issue for the GOP. Republicans are divided both on when to wind down the enhanced funding under Obamacare’s expansion and how much to control spending in the overall program.
“What I see is more and more concerns about Medicaid as a component of" the bill, said Sen. Jerry Moran (R-Kan.).
One camp of Republicans — led by Sens. Shelley Moore Capito of West Virginia and Rob Portman of Ohio — are very reluctant to cut funding for states that expanded the program.
They’re running up against conservatives who see this bill as an opportunity to dramatically rein in spending on the entitlement program — a long-time conservative goal.
There is general consensus around boosting the tax subsidies in the House bill and a general framework of how to reduce premiums. An agreement on Medicaid is unlikely this week, Republicans said, but progress on premiums is more doable.
Senate Republicans also appear poised to preserve Obamacare’s pre-existing condition protections. The House bill allowed states to opt out of rules that required insurance companies to charge everyone the same, with few exceptions. That opened the GOP up to charges that they were not protecting people with pre-existing conditions.
The Senate bill’s pre-existing conditions policy is likely to be “much different from what the House has done and try to cover as many people as the Affordable Care Act did,” Moran said.