GOP pressured to find a way on health care

WASHINGTON - Senate Republicans, having hit an apparent impasse in their long campaign to repeal and replace the Affordable Care Act, return to Washington this week in search of a way forward, with support dwindling, time running out and deep divisions within their ranks.

Options are limited as Senate Majority Leader Mitch McConnell, R-Ky., assesses the legislative landscape for his Obamacare replacement, which has virtually no hope of passing unless it is substantially amended.

The Better Care Reconciliation Act, which threatens to toss 22 million more Americans into the ranks of the uninsured, has been almost universally panned by patient advocacy groups, doctors and other health care providers. It is backed by less than 20 percent of the public, polls show.

And for the last week, Republican lawmakers have faced rowdy crowds back home opposing the repeal bill.

At the same time, GOP senators return to work aware that federal intervention is needed to stabilize some Obamacare insurance markets. If not, insurance premiums in some parts of the country could skyrocket, and many Americans - especially those in rural areas - could be left with few health care options.

Now, with President Donald Trump sending mixed signals on the path forward, Republicans confront the possibility that their promises to end Obamacare might need to be shelved in favor of a bipartisan agreement to improve it.

"For seven years, they pretended like they were all committed to repeal and there were just tactical differences," said Michael A. Needham, CEO of Heritage Action, a leading conservative advocacy group.

"What we learned this year is there are not tactical differences. There are large numbers of Republicans in the House and the Senate who don't want to repeal Obamacare."

That's not the outcome Republicans had in mind when they set out seven years ago to undo President Barack Obama's signature domestic achievement.

But as Congress resumes work this week, McConnell is under mounting pressure to develop a face-saving way out.

"They need to start over," said Dr. Jack Ende, a University of Pennsylvania primary care doctor and president of the American College of Physicians.

"This is a bill that takes away much needed health insurance and health care from the people who need it most. You can't tweak it a little here and little there. ... The right strategy is to work on improving what we have."

Democrats say they are willing to work with Republicans to fix Obamacare but only after the GOP drops its repeal campaign.

Conservatives warn that doing so would be a political disaster for the GOP, sapping enthusiasm for the 2018 midterm elections.

"If this party switches from repeal of Obamacare to a bailout of Obamacare," said Needham, "that is catastrophic."

Even senators are unsure of McConnell's next moves. And the heath care legislation has shown the limits of his ability to cobble together the 50 votes needed from a 52-seat Senate GOP majority. Votes are not expected until mid-July, at the earliest.

"Clearly, the draft plan is dead," said Sen. Bill Cassidy, R-La., a physician who has offered his own proposal.

"Is the serious rewrite plan dead?" he asked in an interview on "Fox News Sunday." "I don't know. I haven't seen the serious rewrite."

McConnell's efforts have been complicated by the deep divisions among Republican senators. The majority leader was forced to put off a vote on the bill last month amid opposition from both conservatives and centrists.

Conservatives want the most complete repeal of Obamacare possible, and they have opened a direct line of negotiation with the White House, appearing to turn Trump to their side, for now.

Sen. Ted Cruz, R-Texas, and Sen. Mike Lee, R-Utah, back a proposal that would dramatically roll back insurance protections in the current law, allowing insurers to offer cheaper, skimpier health policies they say would drive down costs, at least for healthy consumers.

An assessment of Cruz's "consumer choice" plan is expected this week from the nonpartisan Congressional Budget Office.

"There's no doubt this has been a rocky path," Cruz said Sunday on "Face the Nation." "But I continue to believe we can get this done."

But other GOP senators and advocacy groups are warning that Cruz's plan would further destabilize insurance markets by dividing healthier and sicker consumers.

Republican Sen. Chuck Grassley of Iowa said last week he worried that the Cruz amendment could be a "subterfuge" to get around Obamacare's protections for those with pre-existing conditions. "Obviously, I would object to that," he told Iowa Public Radio.

Politically, the Cruz approach does little to help McConnell amass 50 votes for passage. Although it pleases conservatives who say the Senate GOP bill does not go far enough in ending Obamacare's insurance mandates, it is almost certain to drive away more centrist Republicans.

The centrists have been most concerned about steep cuts to Medicaid. McConnell's bill would slash nearly $800 billion from the government's health care safety net over the decade and leave millions of poor Americans without access to care. Particularly hard hit would be poorer, rural counties, many of which backed Trump last year.

In Nevada, the Medicaid cuts would leave nearly 200,000 uninsured, prompting the state's Republican senator, Dean Heller, to oppose the bill.

lisa.mascaro@latimes.com

Credit: By Lisa Mascaro; Noam N. Levey - Washington Bureau - lisa.mascaro@latimes.com

Caption: Senate GOP Leader Mitch McConnell, right, with House Speaker Paul Ryan, put off a vote in June on the health bill.

Pablo Martinez Monsivais/AP