New health bill still uphill for GOP; Medicaid cuts help put revised Senate legislation in peril

WASHINGTON - With their bid to roll back the Affordable Care Act only a vote away from collapse, Republican leaders Thursday scrambled to rally GOP senators behind revised health care legislation in hopes of passing it next week.

The new version - which represents Senate Majority Leader Mitch McConnell's latest bid to unite his fractious caucus - would still enact historic cuts in federal health care assistance to low- and moderate-income Americans and fundamentally scale back Medicaid's half-century-old guarantee of health coverage for the poor.

Two Republican senators said they would oppose the bill, meaning that McConnell needs support on the legislation from all other GOP senators.

The revised bill would further loosen insurance requirements to allow health plans to offer stripped-down, cheaper plans, a move designed to win over skeptical conservative senators.

The new approach also includes a provision to expand the ability of Americans to use tax-deferred Health Savings Accounts to pay insurance premiums, a benefit primarily to those in higher income-tax brackets.

The bill would earmark an additional $70 billion in federal money to help stabilize health insurance markets across the country, funded in part by preserving two Obamacare taxes on wealthy Americans that the previous GOP legislation eliminated.

And in an effort to woo several GOP senators from states dependent on Medicaid to address the opioid crisis, McConnell earmarked an additional $45 billion in the bill to confront the epidemic.

But Medicaid appeared to remain as a major stumbling bloc for at least a half-dozen wavering GOP senators, who met privately with Senate leaders Thursday to discuss ways to protect poor patients, tens of millions of whom stand to lose health protections in the Senate bill.

McConnell, R-Ky., has sought to adjust the legislation after he was forced to abandon a vote last month amid a revolt within his own party. Republicans have promised for seven years to repeal Obamacare, but the process is proving difficult.

The earlier version, which would have left 22 million more Americans uninsured, has been vehemently opposed by leading doctor, patient and other health care advocacy groups.

Several Republican senators said Thursday that they hoped the changes would allow the legislation to advance, and Texas Sen. Ted Cruz, a conservative who opposed the original bill, said Thursday he would now support it.

"I think we're making good progress," said Senate Health Committee Chairman Lamar Alexander, R-Tenn.

But Sens. Susan Collins of Maine and Rand Paul of Kentucky said they would still vote "no." A number of other key lawmakers remained undecided. Every Democrat is expected to oppose the bill.

With 52 members in his caucus, McConnell can afford to lose only two votes and still advance the legislation. Passage remains uncertain, and many senators are skeptical that changes they want could be added once formal debate on the legislation begins as soon as next week.

Many patient advocates and others fiercely oppose the new version.

"The latest proposed changes to the Senate health care bill would make access to health coverage worse for those with preexisting conditions like cancer," said Chris Hansen, president of the American Cancer Society's advocacy arm. "The reluctance by senators to include patient feedback and other relevant stakeholder perspectives in the process is preventing the development of a reasonable, bipartisan consensus that could improve the law and pass the Senate."

Also critical of the bill was Grover Norquist, an influential conservative, who said it was a mistake to retain the two Obamacare taxes - a 3.8 percent investments tax and a 0.9 percent payroll tax - on individuals earning $200,000 or more and couples earning $250,000 or more.

"All Obamacare taxes should be repealed," said Norquist.

Even before the revised bill was released, Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana floated their own rival plan, though it appeared their proposal would not advance.

President Donald Trump told Christian Broadcasting Network founder Pat Robertson in an interview excerpt that aired Wednesday that he "will be very angry" if the Senate doesn't pass its health care legislation.

McConnell has indicated he intends to push ahead once the nonpartisan Congressional Budget Office has reviewed the revised legislation. The agency's estimates are expected Monday.

"We will be voting next week," he said.

McConnell's challenge now appears to be finding support from more than a half dozen Republican senators who remain concerned about Medicaid, including Dean Heller of Nevada, Rob Portman of Ohio, Lisa Murkowski of Alaska, John Hoeven of North Dakota and Cassidy.

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Credit: By Lisa Mascaro ; Noam N. Levey - Washington Bureau - [email protected]

Caption: Senate Majority Leader Mitch McConnell, seen Thursday, must find support for the revised bill from several GOP senators.

Alex Wong/Getty