Senate Republicans hoping to get the bulk of an Obamacare repeal bill done within the next few days keep finding a new problem for every old one they get closer to resolving.
A burst of optimism that they could agree on a more generous version of the House-passed repeal bill was quickly doused by concerns over the cost. An emerging consensus on subsidies to stabilize shaky insurance markets was countered by a threat that crucial abortion restrictions could derail the effort altogether.
And looming over it all, lawmakers are still struggling to bridge the deep divide over the future of Medicaid.
“Building consensus is hard,” Sen. John Cornyn, the chamber’s No. 2 Republican, said earlier this week. “We’ve all got a better idea. But pretty soon we’re going to have to make a decision on a single bill.”
Senate Republicans are trying to hammer out all the disputes in the next couple of weeks, as they aim to write a bill that can pass with a razor-thin majority by the end of June. But already, lawmakers are finding themselves bogged down in negotiations that the GOP hoped to speed through during a series of closed-door meetings.
Majority Leader Mitch McConnell aimed to finalize a draft of the repeal plan within the next few days. But senators are only starting to grapple with potentially painful trade-offs that could make or break the GOP’s seven-year promise to repeal Obamacare.
Navigating the hurdles could soon get even tougher: Republicans are increasingly concerned that prohibitions on abortion coverage tucked into the bill could violate the strict Senate reconciliation rules that the GOP hopes to use to pass a bill with just 50 “yes” votes. That could force senators back to the drawing board on a central element of the repeal plan.
The central difficulty remains trying to find common ground between the GOP’s conservative and moderate wings. The Senate is expected to boost the House-passed Obamacare repeal bill’s subsidies for people purchasing individual insurance coverage — especially those between the ages of 50 and 64 who are just shy of Medicare eligibility — and potentially slow the phase-out of Obamacare’s Medicaid expansion.
The moves are aimed at mollifying swing-state Republicans worried about leaving millions more of their constituents uninsured. But keeping more people covered could mean delaying the elimination of Obamacare’s taxes — a prospect that would trigger heated protests from the Senate’s hardline conservatives.
“There are areas where there’s agreement, there are areas where discussion continues,” said Sen. Ted Cruz, who’s among those eager to eliminate as much of the health law as possible. “The central objective of these discussions is that we want to honor our commitment to repeal Obamacare.”
Sens. Pat Toomey and Rand Paul are also arguing for rolling back the bulk of the taxes tied to Obamacare.
The factions remain similarly dug in on how to tackle Medicaid, a program that Republicans want to drastically overhaul — once they figure out how and when to do it. McConnell has pitched senators on a three-year phase-out of enhanced funding for Obamacare’s Medicaid expansion.
But Sens. Rob Portman and Dean Heller — both representing states that have benefited from the expansion — countered with a seven-year timeline. During a congressional hearing on Thursday, Heller grumbled to HHS Secretary Tom Price that he’s yet to receive clarity from his colleagues about how much money his state might expect under a Republican bill that ends Medicaid’s entitlement status and caps its federal funding.
“I’m just trying to find an answer to this question, and I can’t get it out of our meetings,” Heller said, pressing Price on whether the funding might keep up with health care costs. “I just want to make sure that medical inflation as it increases over the next 10 years, the funding mechanism we have isn’t below that.”
McConnell pledged to bring a bill to a vote by the July 4th recess, a target that likely forces the Republicans to send portions of their legislation to the CBO for scoring as soon as this weekend.
Outside calls for clarity into Republicans’ still-secret talks are likely to come even sooner: Insurers in the Obamacare markets are staring at a June 21 deadline to decide whether they’ll participate for 2018. Already, several have signaled plans to exit because of the uncertainty, leaving counties across the nation with potentially no options on the Obamacare exchanges.
The situation could soon get even worse if the White House abruptly yanks funding for key Obamacare subsidies — a decision the administration increasingly favors, a senior official with knowledge of the deliberations told POLITICO. That risks turning the trickle of insurer exits into a flood, and in the interim is heaping even more pressure on the Senate’s already-fraught negotiations.
“We know there’s going to have to be an infusion in some form,” Sen. John Thune said. “What form that takes is still kind of an open question, which we haven’t settled on yet.”
Dan Diamond contributed to this report.