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Trump Names, Shames GOP Senators as Health Bill Hangs by Thread

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With the latest Republican-only Affordable Care Act change repeal proposal hanging by a thread, President Donald Trump took to his favorite bully pulpit on Saturday to chide lawmakers who’ve announced their opposition or are on the fence.

Trump directed tweets at Sens. Rand Paul of Kentucky and John McCain of Arizona. Both have said they’ll oppose the bill, meaning one more committed “no” will sink the legislation. “I know Rand Paul and I think he may find a way to get there for the good of the Party!” Trump told his 39 million followers.

He also targeted Lisa Murkowski of Alaska, who hasn’t committed to a position so far but voted no on a previous replacement measure. “Alaska had a 200% plus increase in premiums under ObamaCare, worst in the country. Deductibles high, people angry!” Trump said, adding inscrutably, “Lisa M comes through.”

(Related: McCain to Oppose Graham-Cassidy ACA Change Bill)

The president saved the most animus for McCain, who provided the third “no” vote to doom the previous Affordable Care Act repeal bill in July, in a dramatic return to the Senate floor after being diagnosed with an aggressive form of brain cancer.

“John McCain never had any intention of voting for this Bill, which his Governor loves,” Trump tweeted. “He campaigned on Repeal & Replace. Let Arizona down!”

On Friday, McCain said in a statement that he “cannot in good conscience vote for the Graham-Cassidy proposal.” Republicans and Democrats could do better by working together “and have not yet really tried,” McCain said.

McCain was the second Republican to oppose the measure, joining Paul. Sen. Susan Collins said Friday she’s leaning against it, according to a newspaper in her home state of Maine. Senate Republicans can afford to lose no more than two members of their 52-48 majority and pass the bill.

The health bill under discussion was introduced by Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina. Graham is a close friend of McCain — a element of the drama that Trump didn’t leave untouched: “McCain let his best friend L. G. down!”

Graham wrote on Twitter Friday, “My friendship with @SenJohnMcCain is not based on how he votes but respect for how he’s lived his life and the person he is.”

In contrast to the senators’ friendship, the president and McCain have been at odds since then-candidate Trump insulted the former Vietnam War prisoner during a campaign event in 2015: “McCain is a war hero because he was captured, and I prefer people who weren’t captured, okay?”

The Republican drive to gut the Affordable Care Act is using a dramatically shortened legislative process that seeks to transform the act using a bill introduced just two weeks ago.

Hospital and health insurance stocks moved upward after McCain’s announcement. The S&P 500 Managed Health Care Index of insurers pared earlier losses and closed down about 0.5%. A Bloomberg Intelligence index of hospital stocks gained 1.1%.

Senate Majority Leader Mitch McConnell has said he intended to hold a Senate vote next week before a Sept. 30 deadline to use a fast-track budget reconciliation procedure that lets some budget measures get through the Senate with a simple majority vote, rather than the 60 votes usually required. David Popp, a spokesman for McConnell, didn’t immediately respond to a request for comment about McCain’s decision.

Trump warned on Twitter on Friday that “Rand Paul, or whoever votes against Hcare Bill, will forever (future political campaigns) be known as ‘the Republican who saved ObamaCare.’” The president is working the phone on the issue and is “open to having face-to-face meetings,” adviser Kellyanne Conway said on Fox News. “The president is leaning in all the way.”

The White House “just wants a legislative victory, they’re not as concerned with the policy” in the bill, Paul told the Associated Press after Trump’s tweet.

The Brookings Institution estimated Friday that the Graham-Cassidy plan would reduce the number of people with health coverage by about 21 million a year from 2020 through 2026. The number may be larger, it said, because of difficulties in setting up state health systems by 2020 and possible market turmoil in the final years. “What is clear, however, is that the legislation would result in very large reductions in insurance coverage,” Brookings said.

The Center on Budget and Policy Priorities said Medicaid funding cuts would equal 16% of projected state budgets in 2027. “That’s more than what states provide for higher education,” it said.

 Sen. Susan Collins, R-Maine (Photo: Collins)

Sen. Susan Collins, R-Maine (Photo: Collins)

Collins criticized the bill because among other things it undermines protection for people with pre-existing medical conditions, the Portland Press Herald reported on Friday. “The premiums would be so high they would be unaffordable,” she said. Collins may say more in two scheduled political talk show appearances on Sunday.

Murkowski has no immediate plan to announce her position, her office said. Collins and Murkowski were the other two Republicans who opposed McConnell’s bill in July; Paul voted in favor of the earlier legislation.

Lightning-Speed Path

Democrats have denounced the lightning-speed path to a vote, with only one committee hearing on the bill scheduled. Senate Minority Leader Chuck Schumer of New York praised McCain in a statement Friday and said, “I have assured Senator McCain that as soon as repeal is off the table, we Democrats are intent on resuming the bipartisan process.”

After the July defeat of McConnell’s plan, Senate Health Chairman Lamar Alexander and top Democrat Patty Murray of Washington worked on a bipartisan plan to shore up the Affordable Care Act public health insurance exchanges.

Alexander of Tennessee said this week that the effort had failed. Murray said in a statement that the pair had “identified significant common ground,” but that Republican leaders decided to “freeze” the bipartisan effort and push the party’s own plan.

The Graham-Cassidy proposal would turn Affordable Care Act coverage subsidy funds into block grants for the states, which would create their own health care plans for residents. States that expanded Medicaid under the Affordable Care Act would be hardest hit by spending cuts, losing $180 billion from 2020 to 2026, according to the Kaiser Family Foundation. States that rejected the Medicaid expansion, many with Republican leadership, would gain $73 billion.

The measure would end the Affordable Care Act’s requirements that individuals have insurance and that most employers provide it.

It also would end the guarantee that people with pre-existing medical conditions can’t be charged more for insurance. A public dispute between TV comedian Jimmy Kimmel, whose infant son has a congenital heart defect, and the Senate sponsors took on bitter personal terms this week and demonstrated how little is understood about the legislation.

“Thank you @SenJohnMcCain for being a hero again and again and now AGAIN,” Kimmel wrote on Twitter Friday after McCain’s announcement.

—-Read Senate Medicare Vote Hints at ACA Change Resistance on ThinkAdvisor.

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