More than enough Senate Republicans oppose the House bill to kill it — with rival camps insisting on pulling the bill in opposite directions to meet their demands. With just a 52-48 majority, the bill would fail if three or more Republicans vote against it.
Republican leaders face a conundrum: If they move the bill to the right, moderates go running; move it to the left, and conservative opponents dig in.
Whether Republicans would actually tank something they’ve promised for the past seven years is unclear. All of them say they want something to pass, and House leaders unveiled tweaks to the bill Monday evening.
A look at how Senate GOP opposition to the measure breaks down:
Conservatives demanding fuller repeal
A trio of Senate conservatives has attacked the bill vociferously and said they will not vote for it without changes. At least one of the three — Rand Paul of Kentucky, Ted Cruz of Texas and Mike Lee of Utah — has to vote for the bill for it to pass, given united opposition from Democrats.
Paul, who has libertarian leanings, has slammed the bill as “Obamacare lite.” He criticizes it in part as too generous to people who don’t make enough money to pay income taxes, and has urged conservatives in both chambers to withhold their support for negotiating leverage, citing tactics from Donald Trump’s book “The Art of the Deal.” Trump, in turn, has called Paul on more than one occasion as part of what Paul calls a mutual-wooing operation.
Cruz complains the bill could actually lead to higher premiums next year because it doesn’t repeal Obamacare’s insurance mandates — the most costly of which is a ban on pre-existing conditions — and has tried so far without success to get Republicans to embrace a bolder repeal that would include Vice President Mike Pence overruling the Senate parliamentarian on what can be included in the package under the rules.
“I cannot vote for any bill that keeps premiums rising,” he said Sunday on CBS’s Face the Nation.
Defenders of Planned Parenthood
If McConnell and Trump manage to win over at least one of the members of the conservative trio, they still have numerous hurdles to clear among the party’s moderate camps.
Two Senate Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, oppose the House bill’s provision defunding Planned Parenthood — enough to bring the bill to the brink.
Defunding Planned Parenthood has been a major Republican priority for years, and losing that provision could cost conservative votes.
Sen. Bill Cassidy, R-La., shown above at a Health Agents for America meeting, says an ACA replacement should cover more people, not fewer. (Photo: Allison Bell/LHP)
Protecting Medicaid expansion
A broader group has expressed concerns about the House’s plans to phase out Medicaid expansion money for their states, including Murkowski, Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Cory Gardner of Colorado.
Dean Heller of Nevada — the Democrats’ No. 1 target in 2018’s midterm elections and the only Republican running in a state won by Hillary Clinton — declared Friday in a statement he couldn’t vote for the House bill as written because of Medicaid concerns expressed by four Republican governors, including Nevada’s Brian Sandoval.