After deciding Tuesday to delay a vote on the Senate's health reform bill, Senate Majority Leader Mitch McConnell (R-Ky.) is now aiming to reach a consensus on new policy among moderate and conservative senators by this Friday so lawmakers can send the revised bill to the Congressional Budget Office (CBO) over the July 4 recess and hold a vote shortly after they reconvene on July 10.
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Background
GOP leaders had originally planned to vote on the Better Care Reconciliation Act (BCRA) this week, with Senate Majority Whip John Cornyn (R-Texas) saying earlier Tuesday that the vote would happen on Wednesday. But after the Congressional Budget Office released its score of the BRCA, several GOP senators said they would vote against taking up the bill without significant changes.
On Tuesday, McConnell said the Senate would delay its vote on the bill until after the July 4th recess. "We will not be [voting] on the bill this week, but we're still working toward getting at least 50 people in a comfortable place," McConnell said.
Speaking about the change of plans, a GOP aide told Axios, "McConnell wants to win." The new plan, the aide said, is to make changes to the bill, get a new CBO score, "and win."
According to Politico's "Pulse," the decision to delay the vote means that the vote likely will not occur before mid-July, as the Senate will need to go through a series of procedural moves before they could hold a vote.
Who prompted the delay
To pass the bill, McConnell must bridge the gap between moderate GOP senators who say the bill's Medicaid cuts are too steep and conservative GOP senators who say they bill does not go far enough to repeal and replace the Affordable Care Act (ACA).
GOP senators can lose only two votes if all Senate Democrats vote no, as is expected. As of Tuesday evening, at least 10 GOP senators said were opposed to the bill or did not support holding the vote this week:
- Sen. Shelley Moore Capito (W. Va.) said she opposed the bill because it "cuts traditional Medicaid too deeply" and expressed concerns about how the bill would affect the opioid crisis. "More opioid funding would be very good and very beneficial, but the core for me is the Medicaid provision," Capito said.
- Sen. Susan Collins (Maine) said she has "so many fundamental problems with the bill that have been confirmed by the [CBO] report that it's difficult for me to see how any tinkering is going to satisfy my fundamental and deep concerns about the impact of the bill."
- Sen. Dean Heller (Nev.) said the bill "doesn't protect Nevadans on Medicaid."
- Sen. Rand Paul (Ky.) opposed the bill for not going far enough to repeal the ACA, saying the bill "is currently not real repeal."
- Sen. Jerry Moran (Kan.) in a tweet after the vote was delayed said, "The Senate health care bill missed the mark for Kansans and therefore did not have my support."
- Sen. Rob Portman (Ohio) said, "I continue to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic."
- Sen. Ted Cruz (Texas) said he opposed the Senate's bill but described as a "work in progress."
- Sen. Mike Lee (Utah) said, "We can rewrite our bill to bring down the price working families pay for health insurance—while still protecting Americans with pre-existing conditions."
- Sen. Ben Sasse (Neb.) said, "This bill is not a full repeal; this bill is not a full replace; what this bill is is mostly just a Medicaid reform package."
- Sen. Ron Johnson (Wis.) had opposed Senate leaders' rush to pass the bill this week, saying, "I'm just grateful leadership decided, let's take our time, give this more thought and try and get this right."
According to the Washington Post's "PowerPost," Senate GOP leaders could add about $188 billion in new spending to help address senators' concerns without conflicting with reconciliation rules.
But while some lawmakers, such as Sen. John Thune (S.D.), a member of the Senate Republican leadership, said they were hopeful the extra time would help senators reach a consensus on policy, others said the delay could do more harm than good.
Sen. Patrick J. Toomey (Pa.) said the delay "could be good and it could be bad."
White House steps in as McConnell warns against bipartisan fix
McConnell said President Trump will play a larger role in the discussions going forward, and on Tuesday Republican senators met with Trump at the White House.
According to "PowerPost," during the meeting GOP senators shared their concerns about the bill and the process senate GOP leadership used to craft the bill.
President Trump during the meeting told senators, "This will be great if we get it done. And if we don't get it done, it's just going to be something that we're not going to like. And that's OK. I understand that very well."
McConnell after the meeting said if a deal cannot be reached the next step would be to work with Senate Minority Leader Chuck Schumer (D-N.Y.) to stabilize the ACA. "Either Republicans will agree and change the status quo; or markets will continue to collapse and we'll have to sit down with Senator Schumer. ... And my suspicion is that any negotiation with the Democrats would include none of the reforms that we would like to make on the market side and the Medicaid side. So for all of those reasons, we need to come up with a solution," McConnell said (Kaplan/Pear, New York Times, 6/27; Owens, Axios, 6/27; Allen, Axios, 6/27; Sullivan et al., "PowerPost," Washington Post, 6/27; O'Keefe, "Power Post," Washington Post, 6/27; Haberkorn/Everett, Politico, 6/27; Roubein et al., The Hill, 6/27; Kliff, Vox, 6/23; Killough/Barrett, CNN, 6/27).
No matter what happens in the Senate: Get the clinical leader's resource guide
No matter the outcome of the debate over the future of the Affordable Care Act and Medicaid, the likely renewed focus on delivery system costs will make further clinical efficiency an imperative.
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