Senate Moves ACA Change Bill to Slow Lane After House Vote

Senators have proposals of their own

Sen. Lamar Alexander, R-Tenn. (Photo: Alexander) Sen. Lamar Alexander, R-Tenn. (Photo: Alexander)

(Bloomberg) — Passage of H.R. 1628, the House’s health care bill, gives the Obamacare change effort new life after months of wrangling, but key Republican senators are already pushing it aside to write their own bill with no clear timetable to act.

The narrowly passed House measure can’t get anywhere near the 51 votes needed as is, even though Republican senators insist they’re united on delivering on their seven-year vow to repeal and replace the Affordable Care Act. Instead, they want to write their own bill.

(Related: 4 ACA Change Paths That Just Got More Popular)

Lamar Alexander of Tennessee, who chairs the Senate health committee, Rob Portman of Ohio, and Roy Blunt of Missouri, a member of GOP leadership, described the plan even as the House was celebrating passing its repeal after weeks of back-and-forth.

“We’ll write our own bill,” Alexander said in an interview, although he said senators would consider pieces of the House bill. “Where they’ve solved problems we agree with, that makes it a lot easier for us.”

The decision will delay the prospect of any repeal bill reaching President Donald Trump’s desk. Before the failure of the House bill in March, Senate Majority Leader Mitch McConnell had talked of taking it up and passing it in a week.

Slower Debate

A senior White House official said the administration is ready for a slower, more deliberative debate in the Senate, where the main sticking point is expected to be how to address Obamacare’s expansion of Medicaid.

The House bill, which squeaked through the House on a 217-213 vote Thursday, became an even tougher proposition for the Senate with changes made in recent weeks to win over conservatives. Those revisions raised potential procedural hurdles, and also sparked new Republican concerns over how the measure would affect coverage of people with pre-existing conditions.

“If any senator’s got a better idea, I wish them well,” House Majority Whip Steve Scalise of Louisiana told MSNBC on Friday. “What they’re going to find is you have to find consensus. We put 217 votes on the board and it took weeks and weeks to do it because everybody’s got good ideas. Some of them don’t work for other people.”

Suddenly, Senate Republicans are doing their best to downplay expectations for quick action on the ACA.

Chuck Grassley of Iowa, a senior Republican on the Senate Finance Committee, said it will take weeks or maybe months for the Senate to develop a plan because many lawmakers in the chamber haven’t yet engaged on the issue.

“There hasn’t been any health care discussion over here,” Grassley said.

End of the Year

Vice President Mike Pence tipped to that notion on Sunday, when he said on NBC’s “Meet the Press” that he hoped a final version from Congress would get to the president to sign “before the end of the year."

Grassley also said the Senate GOP’s goal should be to attract some Democratic support, even though Republicans are trying to use expedited measures that would allow the bill to pass with only 51 votes.

“As I said with Obamacare, anything that affects so many people and such a big part of the economy should have a solution that can attract bipartisanship,” he said. “Obamacare didn’t achieve that.”

Democrats will negotiate only “if this is about improvements, repairs, reforms, advances” to ACA, Sen. Tim Kaine of Virginia, the party’s vice presidential candidate in 2016, told CNN on Friday. “If it’s just about politics,” he added, “no, we’re not going to participate in slashing health care for millions just to give tax cuts to the richest.”

Alexander, whose Health, Education, Labor and Pensions Committee will have a major role in drafting the Senate version, is beginning to lay out his objectives for the eventual measure.

‘Go to Work On It’

“Our goals are to rescue the people who won’t be able to buy insurance in 2018, to lower premiums, to gradually move Medicaid to the states without pulling the rug out from people, and make sure that people that have pre-existing conditions are covered,” Alexander added. “We’re going to go to work on it.”

Blunt said Republicans will look to see what they can take from the House version, H.R. 1628, as they write their own measure, but before holding a vote they’ll need to see estimates from the Congressional Budget Office for its cost and how it would affect insurance coverage.

Portman said a growing working group including himself, conservative Texas Sen. Ted Cruz, leadership and committee chairmen has been meeting about once a week to try to find a path to 51 votes.

Sen. Rand Paul, R-Ky. (Photo: Paul)

Sen. Rand Paul, R-Ky. (Photo: Paul)



“It’s an attempt to write our own bill,” he said. “We all have ideas and so do a lot of our colleagues so let’s get them all together.”

Alaska’s Lisa Murkowski, who has been very critical of the House bill, said Thursday she hopes the Senate starts with “a clean slate.”

Her focus is on cutting premiums and protecting the Medicaid expansion in her state far more than enacting all of the tax cuts in the House bill.

‘Cost and Access’

“In Alaska people are a lot more concerned with cost and access” than the tax cuts, she said.

To get some kind of bill through his chamber, McConnell will need to unite moderate and conservative wings of the party that want to pull the measure in entirely different directions. The GOP controls the chamber 52-48, meaning he can lose no more than two Republicans and still pass it, given the united Democratic opposition.

A number of moderates were unhappy with a Congressional Budget Office estimate showing an earlier version of the House measure would have resulted in 24 million more people without insurance within a decade.

That wing is led by Bill Cassidy of Louisiana, a doctor who worked for decades in a charity hospital, and Susan Collins of Maine. Together they crafted a more moderate plan that kept the Affordable Care Act’s taxes in place instead of repealing them.

(Related: Collins and Cassidy unveil partial ACA repeal bill)

Other senators who have expressed concerns about the House bill include Tom Cotton of Arkansas and Cory Gardner of Colorado, who both hail from states that have benefited from Obamacare’s Medicaid expansion. The House measure included an $800 billion-plus cut to Medicaid.

That cut also led Shelley Moore Capito of West Virginia, Portman and Murkowski to object to the House bill. It’s unclear whether they would be satisfied by reallocating some of the spending, shrinking the tax cuts, or some combination. Senators have been meeting in small groups and discussing possible amendments.

Fuller Repeal

On the party’s right flank, Cruz and Rand Paul of Kentucky will try to pull any measure closer to a full repeal of the Affordable Care Act while adding conservative planks. It’s not clear how they can do so and still get enough votes to pass the final product.

Cruz said Wednesday he is talking with senators and the administration about ways to improve the bill and bring down premiums. One provision he hopes to add is an amendment allowing insurers to sell coverage across state lines to boost competition. That’s something Trump promised during the campaign, but it could run into procedural objections and political resistance.

Paul, meanwhile, may be the toughest vote to get on the right. The libertarian-minded senator has criticized the House bill for continuing some tax credit payments to insurance companies.

--- Read GOP ACA Plan Takes Hit With CBO's Dire Estimates on ThinkAdvisor.

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