Two more Senate Republicans oppose health-care bill, leaving it without enough votes to pass
By Sean Sullivan and Lenny Bernstein
July 18 at 8:18 AM
The Washington Post
Two more Senate Republicans have declared their opposition to the latest plan
to overhaul the nationfs health-care system, potentially ending a months-long
effort to make good on a GOP promise that has defined the party for nearly a
decade and been a top priority for President Trump.
Sens. Mike Lee (Utah) and Jerry Moran (Kan.) issued statements declaring that
they would not vote for the revamped measure. The sudden breaks by Lee, a
staunch conservative, and Moran, an ally of Senate Majority Leader Mitch
McConnell (R-Ky.), rocked the GOP leadership and effectively closed what already
had been an increasingly narrow path to passage for the bill.
They joined Sens. Rand Paul (Ky.) and Susan Collins (Maine), who also oppose
it. With just 52 seats, Republicans can afford to lose only two votes to pass
their proposed rewrite of the Affordable Care Act. All 46 Democrats and two
independents are expected to vote against it.
In a pair of tweets Tuesday morning, Trump decried the defections, called for
letting the Affordable Care Act gfailh and vowed to keep pushing for a GOP
plan.
gWe were let down by all of the Democrats and a few Republicans. Most
Republicans were loyal, terrific & worked really hard. We will return!h he
wrote in the first tweet.
He followed that with: gAs I have always said, let ObamaCare fail and then
come together and do a great healthcare plan. Stay tuned!h
Republicans, who have made rallying cries against
President Barack Obamafs 2010 health-care law a pillar of the partyfs identity,
may be forced to grapple with the lawfs shift from a perennial GOP target to an
accepted, even popular, provider of services and funding in many states, which
could make further repeal revivals difficult.
Meanwhile, Trump and other Republicans will confront a Republican base that,
despite fervent support for the president, still seeks a smaller federal
government and fewer regulations.
All of these forces remained vexing factors Monday as senators bailed on the
bill. And no evident solution was offered by the White House — which has been
limited in its sale of the GOP plan — or from McConnell, for how to bring
together a party in which moderates and conservatives are still deeply divided
over the scope of federal health-care funding and regulations.
McConnell did announce late Monday that he plans to push for a vote in the
coming days anyway, but with a catch: senators would be voting to start debate
on the unpopular House-passed bill. McConnell has promised to amend the bill to
a pure repeal, but with no guarantee that such an amendment would pass.
gIn addition to not repealing all of the Obamacare taxes, it doesnft go far
enough in lowering premiums for middle class families; nor does it create enough
free space from the most costly Obamacare regulations,h Lee said in a
statement.
Moran said the bill gfails to repeal the Affordable Care Act or address
healthcarefs rising costs.h
The two senators timed the release of their statements and made clear that
modest tinkering around the edges of the legislation drafted by McConnell would
not be enough to meet their demands.
They joined a pair of GOP colleagues in calling for a complete redrawing of
the legislation that would take many months, short-circuiting McConnellfs wish
to end the debate this month.
The news threw the effort to pass the legislation into turmoil, with
additional Republicans weighing in on Twitter about a flawed process that must
take a new direction. Trump tweeted that gRepublicans should just REPEAL failing
ObamaCare now & work on a new Healthcare Plan.h
Sen. Lindsey O. Graham (S.C.) called for a gnew approachh while Rep. Mark
Meadows (N.C.) tweeted, gTime for full repeal.h White House aides, meanwhile,
said they still plan to press ahead.
The setbacks appear to have left McConnell and House Speaker Paul D. Ryan
(R-Wis.) with few good options. Conservatives have suggested moving a bill that
would simply repeal the Affordable Care Act and set up a timeline of several
years to figure out how to replace it, a politically risky move that also might
lack support to pass.
Another move, which McConnell threatened recently, would be to work with
Democrats to prop up the insurance exchange markets that have been imploding in
some states — which probably would win passage but would infuriate the
conservative base that has been calling for the end of the Affordable Care Act.
gRegretfully, it is now apparent that the effort to repeal and immediately
replace the failure of Obamacare will not be successful,h McConnell said in a
statement released late Monday. He revealed plans to move forward with a vote in
the coming days anyway, in some ways daring his Republican opponents to begin
debate and open the legislation up to amendments.
Democrats quickly jumped at the opportunity to declare the effort dead.
gThis second failure of Trumpcare is proof positive that the core of this
bill is unworkable,h said Minority Leader Charles E. Schumer (N.Y.). gRather
than repeating the same failed, partisan process yet again, Republicans should
start from scratch and work with Democrats on a bill that lowers premiums,
provides long-term stability to the markets and improves our health-care
system.h
Republican leaders had returned to the Capitol on Monday still pledging to
press ahead with plans to pass a far-reaching overhaul, but the day had begun
with uncertainty as the health of Sen. John McCain put the future of the
flagging effort deeper in doubt.
In a speech on the Senate floor, McConnell said that
he had spoken with McCain (R) on Monday morning and that ghefll be back with us
soon.h The Arizonan is recovering from surgery to remove a blood clot above his
left eye that involved opening his skull.
McConnell had delayed action on the health-care bill until McCainfs
return in hopes that he could be persuaded to vote yes. That hope faded after
Leefs and Moranfs announcements, however, with McCain issuing a statement from
Arizona calling for a fresh, bipartisan start.
gOne of the major problems with Obamacare was that it was written on a strict
party-line basis and driven through Congress without a single Republican vote,h
McCain said. gAs this law continues to crumble in Arizona and states across the
country, we must not repeat the original mistakes that led to Obamacarefs
failure.h
In addition, Sen. Ron Johnson (R-Wis.) hinted Monday that he might vote
against advancing the measure to floor debate — departing from his posture last
week.
McCain, 80, is awaiting results of tissue pathology reports
gpending within the next several days,h the hospital treating him said in a
statement over the weekend. He will be away from the Senate for at least the
rest of the week. A McCain spokeswoman had no further update on his
condition Monday.
Graham, perhaps McCainfs closest friend in the Senate, spoke to him by phone
as he was walking to the Senate chamber for a vote Monday evening. The two had
an animated conversation, and Graham said McCain was gdying to get back.h
gThey were doing a routine checkup and they found the spot and it looks like
everything is going to be A-okay,h Graham said. He said McCainfs doctors gdonft
want him to fly for a week, adding, gI think he would walk back if they would
let him.h
The cause of McCainfs blood clot remained unclear Monday. The most
common causes of clots in the head, especially for older people, are falls, car
crashes and other incidents that cause traumas, even minor ones, said Elliott
Haut, a trauma surgeon at the Johns Hopkins University School of Medicine. By one
estimate, 1.7 million people suffer traumatic head injuries each year,
with motor vehicle accidents the leading cause and blood clots that affect the
brain a common effect.
Traumas can cause blood to leak out of small vessels in two locations in the
head: between the brain and a tough, fibrous layer known as the dura, causing
gsubdural hematomas,h and between the dura and the skull, causing gepidural
hematomas.h
gPeople die of these every day,h Haut said in an interview, emphasizing that
he could not speak about McCainfs health, because he had no details of the
case.
Another possibility is that the clot is related to McCainfs history of
melanoma, a dangerous form of skin cancer that can spread to other organs,
including the brain, and form new tumors. Haut said that is much less likely but
not impossible. Diagnosis of a clot in the head requires a CT scan, and it often
follows symptoms such as headaches or blurred or changed vision, he said.
Senate Republicans have been under self-imposed pressure to complete their
work on health care. As they have struggled to show progress, McConnell has said he would keep the chamber in session through the first
two weeks of August, postponing the start of the summer recess period to leave
time to work on other matters.
Key Republican senators — and the GOP governors they turn to for guidance —
have raised concerns about how the bill would affect the most vulnerable people
in their states. Private lobbying by the White House and Senate GOP leaders has
not mollified them.
Johnson said Monday that last week he was gstrongly in favorh of taking a
procedural vote allowing the bill to advance to floor debate. But he said he was
unhappy with recent comments by McConnell that the billfs deepest Medicaid cuts
are far into the future and are unlikely to take effect anyway.
Johnson said he read the comments in The Washington Post and confirmed them with
other senators. He said he planned to talk to McConnell about it Tuesday at the
weekly GOP policy lunch. In a statement late Monday, McConnell responded: gI
prefer to speak for myself, and my view is that the Medicaid per capita cap with
a responsible growth rate that is sustainable for taxpayers is the most
important long-term reform in the bill. That is why it has been in each draft we
have released.h
New York Attorney General Eric Schneiderman, a Democrat, threatened Monday to
sue the federal government if the health-care bill becomes law. The measure
gisnft simply unconscionable and unjust. Itfs unconstitutional,h he wrote on
Twitter.
The Schumer letter also asks that GOP leaders not move ahead with the bill
until the nonpartisan Congressional Budget Office releases a complete score on
it. The CBO had been expected to release its findings as soon as Monday, but
that did not happen. A GOP aide, who spoke on the condition of anonymity to
discuss the matter candidly, said a release later this week was possible but not
certain.
The CBO has been projecting what the bill would do to insurance coverage
levels, premium costs and the federal budget deficit. Having an unfavorable
report in the public domain for an extended period of time with an uncertain
date for a vote would fuel criticsf argument against the bill, making it harder
for McConnell to round up votes for it.
A CBO
report on an earlier version of the legislation projected that it would
result in 22 million fewer Americans with insurance by 2026 than under
current law. It predicted that the measure would reduce the budget deficit by
$321 billion over the same period. On average, premiums would first rise,
then fall under the measure, the CBO projected.
Neither a McConnell spokesman nor the CBO said when the new report would be
released or why it was not released Monday.
White House officials have been seeking to cast doubt on the findings from
the CBO and other independent analyses of the bill. But some key Republicans
responded with skepticism.
Over the weekend, influential Republican governors said
they were not sold, even after talking privately with the officials during
the National Governors Associationfs summer meeting.
[Nevadafs governor still doesnft support the Senate health-care
bill. Thatfs big trouble for Republicans.]
Several key GOP senators have voiced concerns about the measurefs long-term
federal spending cuts to Medicaid. Others have said the bill would not go far
enough in overhauling the Affordable Care Act. The opposing pressures have left
McConnell in a tough position in which he has struggled to find a solution.
In the meantime, Senate Republican leaders plan to focus on trying to confirm
more Trump administration nominees and some less far-reaching legislative goals.
As they do, they will be watching for updates on McCainfs condition.
gFollowing a routine annual physical,h the Mayo Clinic Hospital in Phoenix
said Saturday, McCain gunderwent a procedure to remove a blood clot from above
his left eye on Friday, July 14.h The hospital added that gsurgeons successfully
removed the 5-cm blood clot during a minimally invasive craniotomy with an
eyebrow incision.h
Acute subdural hematomas can be fatal half the time
and even more often in older people. They can also cause strokes. Unlike clots
in the legs and lungs, they must be treated through surgery, rather than blood
thinners, Haut said.
In 2009, actress Natasha Richardson died of the effects of
an epidural hematoma after declining medical attention following a fall while
skiing.
It is not known whether McCain takes blood thinners, but
those can make it more likely that blood will escape from vessels after a
trauma, Haut said.
Evan Wyloge in Phoenix and Paul Kane, Robert Costa, Kelsey Snell, Abby
Phillip and William Branigin in Washington contributed to this report.